Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Abstract

Background: To determine the impact of the COVID-19 pandemic on the population with chronic Hepatitis B virus (HBV) infection under hospital follow-up in the UK, we quantified the coverage and frequency of measurements of biomarkers used for routine surveillance (alanine transferase [ALT] and HBV viral load). Methods: We used anonymized electronic health record data from the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC) pipeline representing five UK National Health Service (NHS) Trusts. Results: We report significant reductions in surveillance of both biomarkers during the pandemic compared to pre-COVID-19 years, both in terms of the proportion of patients who had ≥1 measurement annually, and the mean number of measurements per patient. Conclusions: These results demonstrate the real-time utility of HIC data in monitoring health-care provision, and support interventions to provide catch-up services to minimise the impact of the pandemic. Further investigation is required to determine whether these disruptions will be associated with increased rates of adverse chronic HBV outcomes.

Cohort Profile: The National Institute for Health Research Health Informatics Collaborative: Hepatitis B Virus (NIHR HIC HBV) research dataset

“…During the COVID-19 pandemic, we have investigated service disruptions, revealing that reduction in rates of surveillance closely track COVID-19 incidence and periods of population lock-down. 22 Using this dataset, we have reported a bimodal viral load distribution 23 and found evidence of a virological set point in untreated patients. 23 , 24 In a comparison of tenofovir disoproxil fumarate (TDF)-treated vs untreated patients, we reported variable ethnicity distributions across the two groups and some evidence for liver fibrosis progression in the untreated group, highlighting a need for further evidence for expanded treatment.…”

Analysis of electronic health record data of hepatitis B virus (HBV) patients in primary care: hepatocellular carcinoma (HCC) risk associated with socioeconomic deprivation and reduced by statins

“…However, a substantial proportion of treatment data may be missing from primary care records, as this information is typically captured in secondary/tertiary care records where HBV prescribing is based (61). For example, 16% of CHB patients in secondary care were receiving antiviral treatment, based on the NIHR Health Informatics Collaborative (HIC) database (62). Our primary care cohort may systematically differ to samples in clinical trials and hospital-based cohorts whereby only a small proportion of individuals are treatment-eligible in our cohort.…”