Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics.
OBJECTIVE
To analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital.


METHODS
We performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patientswho required liver biopsy.


RESULTS
We diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity > or = 2, and 23.5% had fibrosis > or = 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year).


CONCLUSIONS
Despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce.
Department of Digestive Diseases, Hospital Universitario Príncipe de Asturias, Ctra. de Mero, s/n. 28805 Alcalá de Henares, Madrid, Spain. epoves.hupa@salud.madrid.org
Elvira
E
Poves-Martínez
David
D
del Pozo-Prieto
Belén
B
Costero-Pastor
Gloria
G
Borrego-Rodríguez
Inmaculada
I
Beceiro-Pedroño
Cecilia
C
Sanz-García
José Ignacio
JI
Busteros-Buraza
María Rosa
MR
González Palacios
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood; D024882:Drug Resistance, Viral; D054242:Emigrants and Immigrants; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus; D003699:Hepatitis D / Q000453:epidemiology; D003698:Hepatitis Delta Virus; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase