title: The diversity and management of chronic hepatitis B virus infections in the United Kingdom: a wake-up call.
abstract: BACKGROUND
  Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom.
  
  
  METHODS
  A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected.
  
  
  RESULTS
  Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low.
  
  
  CONCLUSIONS
  We demonstrated diversity of chronic HBV infections in UK patients, suggesting that optimal management requires awareness of the variable patterns of chronic HBV in countries of origin. We also found less-than-optimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.
authors.affiliation: Microbiology Services-Colindale, Health Protection Agency, London, UK.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Tedder
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Rodger
authors.forename: Lori
authors.initials: L
authors.lastname: Fries
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.forename: Mark
authors.initials: M
authors.lastname: Thursz
authors.forename: William
authors.initials: W
authors.lastname: Rosenberg
authors.forename: Nikolai
authors.initials: N
authors.lastname: Naoumov
authors.forename: Jangu
authors.initials: J
authors.lastname: Banatvala
authors.forename: Roger
authors.initials: R
authors.lastname: Williams
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.forename: Shilpa
authors.initials: S
authors.lastname: Chokshi
authors.forename: Terry
authors.initials: T
authors.lastname: Wong
authors.forename: Gillian
authors.initials: G
authors.lastname: Rosenberg
authors.forename: Sulleman
authors.initials: S
authors.lastname: Moreea
authors.forename: Margaret
authors.initials: M
authors.lastname: Bassendine
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mills
authors.forename: David
authors.initials: D
authors.lastname: Mutimer
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Ryder
authors.forename: Andrew
authors.initials: A
authors.lastname: Bathgate
authors.forename: Hyder
authors.initials: H
authors.lastname: Hussaini
authors.forename: John F
authors.initials: JF
authors.lastname: Dillon
authors.forename: Mark
authors.initials: M
authors.lastname: Wright
authors.forename: George
authors.initials: G
authors.lastname: Bird
authors.forename: Jane
authors.initials: J
authors.lastname: Collier
authors.forename: Michael
authors.initials: M
authors.lastname: Anderson
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology