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Delayed HBV, HCV diagnosis may increase advanced liver disease

Despite rates of hepatitis B- and hepatitis C-related cirrhosis and hepatocellular carcinoma declining over the years in New South Wales, Australia, researchers insist that delayed infection notification can lead to increased risk for advanced liver disease and hepatitis screening efforts should be enforced for prevention purposes, per published findings.

Researchers, including Maryam Alavi, BSc, MSc, PhD, research associate at The Kirby Institute, Australia, and Gregory J. Dore, MD, head of the Viral Hepatitis Clinical Research Program at The Kirby Institute at University New South Wales conducted a population-based study using linked data on HBV and HCV notifications to the NSW Admitted Patients Data Collection database and the NSW Registry of Births, Deaths and Marriages. The researchers established a “late hepatitis notification” as someone who was diagnosed with HBV or HCV after, at the time of or within 2 years before decompensated cirrhosis or HCC diagnosis.

Gregory J. Dore

“A definition of late hepatitis notification has not been previously suggested,” the researchers wrote. “We have framed the definition in the context of a potential ‘missed opportunity’ for antiviral therapy prevention of advanced liver disease complications.”

Between 1995 and 2012, individuals with HBV (n = 50,958) and HCV (n = 79,727) in New South Wales were notified. Between January 2001 and December 2013, 3,869 were diagnosed with decompensated cirrhosis and 1,656 were diagnosed with HCC.

Of those diagnosed with decompensated cirrhosis, 885 had HBV-related decompensated cirrhosis diagnosis, and 43% had a late HBV notification (n = 381). However, this late HBV notification declined from 64% during 2001 and 2002 to 31% during 2011 and 2012 (P < .001). A total of 2,984 had HCV-related decompensated cirrhosis. Of these, 29% had a late HCV notification (n = 3,857), which also declined during these periods, from 52% during 2001 and 2002 to 22% during 2011 and 2012 (P < .001).

A total of 1,656 people were diagnosed with HCC. Of these, 665 had an HBV-related HCC diagnosis. Thirty-eight percent of people had a late HBV notification; this declined from 68% during 2001 and 2002 to 29% during 2011 and 2012 (P < .001). Late HCV notification was found in 22% of people diagnosed with HCV-related HCC (221/991); this notification also declined during these periods, from 51% during 2001 and 2002 to 17% during 2011–2012 (P < .001).

“Despite significant declines in late hepatitis notification since early 2000s, efforts to enhance hepatitis screening, particularly for HBV, are required,” the researchers concluded. “Late hepatitis notification as described in this study could be used as a measure of population-level HBV/HCV screening.”

Disclosure: Alavi reports no relevant financial disclosures. Dore reports multiple financial relationships with AbbVie, Abbott Diagnostics, Bristol-Myers Squibb, Gilead Sciences, Janssen and Roche. Please see the study for a list of all other researchers’ relevant financial disclosures.