title: Clinical, epidemiological characteristics and indications for liver biopsy and treatment in immigrants with chronic hepatitis B at a referral hospital in Madrid.
abstract: The increase in immigration from less developed countries to Europe has led to an increase in the incidence of hepatitis B infection. The objective of this study was to describe the clinical, epidemiological characteristics and indications for treatment of chronic hepatitis B in a cohort of immigrants, given the relative lack of current evidence. We performed a noninterventional retrospective chart review; different characteristics depending on geographical origin were compared. A case-control study was also performed to describe factors potentially associated with chronic or past hepatitis B virus (HBV) infection. We selected a random sample of 436 patients out of the 2989 immigrants attending during the study period (1989-2008). Hepatitis B serology was performed in 74% (322/436): 10.6% had chronic HBV infection (95% CI: 7.4-13.7%), and 46.9% had evidence of past infection (95% CI: 41.7-52.0%). The average age was 31 years, 60% were men, and 70% were sub-Saharan Africans. Chronic infection was related to being men (OR 2.03; 95%CI: 1.29-3.18), younger (OR 0.98; 0.96-0.99) and sub-Saharan African (OR 5.41; 2.71-10.83). Past or current infection was related to male sex (OR 2.80; 1.81-4.30), longer time elapsed until first seen at the unit (OR 0.998; 0.997-1.000), HIV infection (OR 4.99; 1.15-21.60) and being sub-Saharan African (OR 15.46; 8.97-27.18). These associations were not confirmed after adjustment for geographical origin. In 27% and 29.5% of patients, liver biopsy and treatment, respectively, would have been indicated. Prevalence of chronic HBV infection amongst immigrants is high, especially in sub-Saharan Africans. Almost a third could be considered for liver biopsy or antiviral therapy.
authors.affiliation: Tropical Medicine and Clinical Parasitology Unit, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain. japerezm.hrc@salud.madrid.org
authors.forename: J A
authors.initials: JA
authors.lastname: Pérez-Molina
authors.forename: J M
authors.initials: JM
authors.lastname: Herrero-Martínez
authors.forename: F
authors.initials: F
authors.lastname: Norman
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Ayala
authors.forename: B
authors.initials: B
authors.lastname: Monge-Mahillo
authors.forename: M
authors.initials: M
authors.lastname: Navarro-Beltrá
authors.forename: R
authors.initials: R
authors.lastname: López-Vélez
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D054242:Emigrants and Immigrants; D005260:Female; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D006761:Hospitals; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult