Causes of death in patients with hepatitis B: A natural history cohort study in the United States

Hepatology ◽  
2012 ◽  
Vol 58 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Jean-Luc Szpakowski ◽  
Lue-Yen Tucker
Keyword(s):  
United States ◽  
Cohort Study ◽  
Natural History ◽  
Hepatitis B ◽  
Causes Of Death ◽  
The United States

scholarly journals Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Mindie H. Nguyen ◽  
Grace Wong ◽  
Edward Gane ◽  
Jia-Horng Kao ◽  
Geoffrey Dusheiko
Keyword(s):  
United States ◽  
Hepatitis B Virus ◽  
Natural History ◽  
Hepatitis B ◽  
Linkage To Care ◽  
The United States ◽  
Hbv Infection ◽  
Care Providers ◽  
Curative Therapy ◽  
B Virus

SUMMARY Currently, despite the use of a preventive vaccine for several decades as well as the use of effective and well-tolerated viral suppressive medications since 1998, approximately 250 million people remain infected with the virus that causes hepatitis B worldwide. Hepatitis C virus (HCV) and hepatitis B virus (HBV) are the leading causes of liver cancer and overall mortality globally, surpassing malaria and tuberculosis. Linkage to care is estimated to be very poor both in developing countries and in high-income countries, such as the United States, countries in Western Europe, and Japan. In the United States, by CDC estimates, only one-third of HBV-infected patients or less are aware of their infection. Some reasons for these low rates of surveillance, diagnosis, and treatment include the asymptomatic nature of chronic hepatitis B until the very late stages, a lack of curative therapy with a finite treatment duration, a complex natural history, and a lack of knowledge about the disease by both care providers and patients. In the last 5 years, more attention has been focused on the important topics of HBV screening, diagnosis of HBV infection, and appropriate linkage to care. There have also been rapid clinical developments toward a functional cure of HBV infection, with novel compounds currently being in various phases of progress. Despite this knowledge, many of the professional organizations provide guidelines focused only on specific questions related to the treatment of HBV infection. This focus leaves a gap for care providers on the other HBV-related issues, which include HBV’s epidemiological profile, its natural history, how it interacts with other viral hepatitis diseases, treatments, and the areas that still need to be addressed in order to achieve HBV elimination by 2030. Thus, to fill these gaps and provide a more comprehensive and relevant document to regions worldwide, we have taken a global approach by using the findings of global experts on HBV as well as citing major guidelines and their various approaches to addressing HBV and its disease burden.

scholarly journals Maternal Hepatitis B Infection and Pregnancy Outcomes in the United States: A Population-Based Cohort Study

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Kristina L Bajema ◽  
Helen C Stankiewicz Karita ◽  
Mark W Tenforde ◽  
Stephen E Hawes ◽  
Renee Heffron
Keyword(s):  
United States ◽  
Cohort Study ◽  
Hepatitis B ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Placenta Previa ◽  
The United States ◽  
Population Based ◽  
Large For Gestational Age ◽  
Hepatitis B Infection

Abstract Background Hepatitis B virus (HBV) infection in pregnancy has been associated with risk of adverse maternal and infant outcomes in highly endemic settings, but this association is not well characterized in the United States. Methods We conducted a retrospective population-based cohort study in Washington State using linked birth certificate and hospital discharge records from 1992–2014. Among pregnant women with hepatitis B (n = 4391) and a hepatitis B–negative group (n = 22 410), we compared the risk of gestational diabetes, pre-eclampsia, eclampsia, placenta previa, preterm delivery, low birthweight, small for gestational age, and large for gestational age using multivariate logistic regression. Results Hepatitis B–infected pregnant women were more likely to be Asian (61% vs 8%, P < .001), foreign-born (76% vs 23%, P < .001), and older in age (77% vs 64% ≥26 years, P < .001). They were less commonly overweight or obese (33% vs 50%, P < .001). There was a lower risk of small for gestational age infants among HBV-infected women (adjusted RR [aRR], 0.79; 95% confidence interval [CI], 0.67–0.93). The risk of other adverse outcomes was not significantly different between hepatitis B–infected and –negative women (gestational diabetes: aRR, 1.11; 95% CI, 0.92–1.34; pre-eclampsia: aRR, 1.06; 95% CI, 0.82–1.35; eclampsia: aRR, 2.31; 95% CI, 0.90–5.91; placenta previa: aRR, 1.16; 95% CI, 0.35–3.84; preterm delivery: aRR, 1.15; 95% CI, 0.98–1.34; low birth weight: aRR, 1.08; 95% CI, 0.90–1.29; large for gestational age: aRR, 1.01; 95% CI, 0.82–1.24). Conclusions In a low-burden setting in the United States, hepatitis B infection was not associated with adverse pregnancy outcomes.

scholarly journals Models to Predict Hepatitis B Virus Infection Among Patients With Cancer Undergoing Systemic Anticancer Therapy: A Prospective Cohort Study

2018 ◽  
Vol 36 (10) ◽  
pp. 959-967 ◽  
Author(s):  
Jessica P. Hwang ◽  
Anna S. Lok ◽  
Michael J. Fisch ◽  
Scott B. Cantor ◽  
Andrea Barbo ◽  
...  
Keyword(s):  
United States ◽  
Cohort Study ◽  
Hepatitis B ◽  
Hepatitis B Surface Antigen ◽  
Anticancer Therapy ◽  
The United States ◽  
Hbv Infection ◽  
Patients With Cancer ◽  
Screening Strategies ◽  
B Virus

Purpose Most patients with cancer are not screened for hepatitis B virus (HBV) infection before undergoing anticancer therapy, and optimal screening strategies are unknown. We sought to develop selective HBV screening strategies for patients who require systemic anticancer therapy. Methods This prospective cohort study included adults age ≥ 18 years with solid or hematologic malignancies who received systemic anticancer therapy at a comprehensive cancer center during 2013 and 2014. Patients underwent hepatitis B surface antigen, hepatitis B core antibody, and hepatitis B surface antibody testing, and completed a 19-question modified Centers for Disease Control and Prevention (CDC) HBV survey. Multivariable models that predict chronic or past HBV infection were developed and validated using bootstrapping. Results A total of 2,124 patients (mean age, 58 ± 13 years) completed the risk survey and HBV testing. Of these, 54% were women; 77% were non-Hispanic white, 11% Hispanic, 8% black, and 4% Asian; and 20% had a hematologic malignancy and 80% a solid tumor. Almost 12% were born outside the United States. The prevalence was 0.3% for chronic HBV infection and 6% for past HBV infection. Significant predictors of positive hepatitis B surface antigen or hepatitis B core antibody tests were as follows: men who had sex with men, black or Asian race, birthplace outside the United States, parent’s birthplace outside the United States, household exposure to HBV, age ≥ 50 years, and history of injection drug use. The area under the receiver operating characteristic curve of the model on the basis of these seven predictors was 0.79 (95% CI, 0.73 to 0.82). The modified CDC survey and brief tools with fewer than seven questions yielded similar false-negative rates (0% and 0% to 0.7%, respectively). Conclusion An internally validated risk tool performed as well as the modified CDC survey; however, more than 90% of patients who completed the tool would still require HBV testing. Universal HBV testing is more efficient than risk-based screening.

Bringing the Real World of Science to Children: A Partnership of the American Museum of Natural History and the City University of New York

2008 ◽  
Vol 12 (1) ◽  
Author(s):  
Anthony G Picciano ◽  
Robert V. Steiner
Keyword(s):  
United States ◽  
New York ◽  
Natural History ◽  
Local Governments ◽  
Compulsory Education ◽  
Development Program ◽  
The United States ◽  
American Museum ◽  
The World ◽  
The City

Every child has a right to an education. In the United States, the issue is not necessarily about access to a school but access to a quality education. With strict compulsory education laws, more than 50 million students enrolled in primary and secondary schools, and billions of dollars spent annually on public and private education, American children surely have access to buildings and classrooms. However, because of a complex and competitive system of shared policymaking among national, state, and local governments, not all schools are created equal nor are equal education opportunities available for the poor, minorities, and underprivileged. One manifestation of this inequity is the lack of qualified teachers in many urban and rural schools to teach certain subjects such as science, mathematics, and technology. The purpose of this article is to describe a partnership model between two major institutions (The American Museum of Natural History and The City University of New York) and the program designed to improve the way teachers are trained and children are taught and introduced to the world of science. These two institutions have partnered on various projects over the years to expand educational opportunity especially in the teaching of science. One of the more successful projects is Seminars on Science (SoS), an online teacher education and professional development program, that connects teachers across the United States and around the world to cutting-edge research and provides them with powerful classroom resources. This article provides the institutional perspectives, the challenges and the strategies that fostered this partnership.

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