[Epidemiology of hepatitis B in Germany].
OBJECTIVE
Little is known about the epidemiology of chronic hepatitis B virus (HBV) infection in Germany. The present study analyzes demographic, socioeconomic and virologic data of a cohort of German HBV-infected patients.


METHODS
As a project of the Hepatitis Competence Network, 250 outpatients with chronic HBV infection were included during the last 5 years.


RESULTS
Mean age was 40.5+/-14.6 years; 63.2% were men. HBV-DNA was negative by polymerase chain reaction in 12.8%; alanine aminotransferase ALT) was normal in 56.3%; even at DNA levels>1 million copies/ml ALT was normal in 38% ("immunotolerance"). About one third of patients were born in Germany, Turkey or one of 34 other countries. The unemployment rate in migrants from Turkey and other countries was more than three times the rate of subjects born in Germany; this difference, however, is the same in non-HBV-infected subjects. In the total cohort HBeAg-negative subjects were more frequent than HBeAg-positive subjects (66.4% vs. 33.6%). About 40% of patients with a liver biopsy had significant fibrosis (F2-4). Multivariate regression showed that significant fibrosis was associated only with age and ALT, but not with HBV-DNA or other variables. 38.4% of subjects had antiviral therapy; the rate of therapy increased with increasing DNA and ALT. The majority of treated patients received lamivudine (58%), adefovir (31%), or both (5%). Only 3% each received interferon or other antivirals.


CONCLUSIONS
The present cohort study shows that about two thirds of HBV-infected subjects who live in the Ruhrgebiet originate from migrants many of whom have significant economic problems. Special programs should be designed for migrants in order to detect HBV infection and to inform infected subjects about their individual and infectious risks.
Niederau
Claus
C
Katholische Kliniken Oberhausen gGmbH, Klinik für Innere Medizin, St. Josef Hospital, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen, Germany. claus.niederau@st-josef.de
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006306:Health Surveys; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000998:Antiviral Agents; D004279:DNA, Viral