Highly dynamic changes of regional HBV epidemiology over two decades

Background & Aim: HBV epidemiology is highly heterogeneous and rapidly evolving worldwide: we stud-ied its last two-decades dynamics in a large single center cohort. Methods: In all consecutive HBsAg-positive subjects firstly admitted (20 0 0-2019) at the Pisa-University -Hospital Hepatology-Referral-Center, demographic, virologic and clinical variables were analyzed by ad-mission decade (20 0 0-20 09 vs 2010-2019) and origin (Italian vs non-Italian natives). Results: Of 2003, 1878 (93.7%) subjects were eligible: 1798(95.7%) with HBV-chronic [126(7%) HDV, 72(4%) HCV, 11(0.6%) HIV co-infected] and 80(4.3%) HBV-primary infections (93.7% Italians). Among 1589(88.4%) mono-infected, 496(31.2%) were immigrants, younger than Italians [34.0(5.1-77.1)-52.5(10.0- 87.2) years], with female prevalence [204/496(41.1%)-340/1093(31.1%); p < 0.001] increasing overtime (14.6-45.0%; p < 0.001). Italians aged across decades [50.3(11.1-87.2)-56.2(10.0-86.7) years; p < 0.001], HBeAg-positivity remained stable (12.3-14.5%) and acute hepatitis increased (4.0-8.0%; p = 0.003). CHB declined [439/721(60.9%)-320/868(36.9%); p < 0.001] whereas HBeAg-negative infection increased [277/626(44.2%)-538/755(71.3%); p < 0.001]. Cirrhosis declined [195/721(27.0%)-125/868(14.4%); p < 0.001], except in anti-HDV-patients [93/126(73.8%); 42(45.1%) non-Italians], younger than HBV-mono-infected (47.4-57.6 years; p < 0.001). Conclusion: Effective preventive health care policies and immigration flows account for increasing preva-lence of HBeAg-negative infection across the last two decades. Antiviral therapy mitigated disease pro-gression in aging Italian CHB but not in CHD patients, mainly young immigrants, emphasizing the unmet need of effective CHD therapies; HBeAg-positive CHB and acute hepatitis B persist in non-vaccinated Ital-ian adults, prompting vaccination in the elderly with risky behaviors. (c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study examined the epidemiology of HBV in a large single center cohort over the past two decades, revealing changes in the characteristics and trends of HBV infection. Differences were observed between Italian and non-Italian immigrants, with age and gender playing important roles in the infected population. The prevalence of chronic HBV decreased, while HBeAg-negative infection increased. The incidence of cirrhosis declined, except for patients with ongoing HDV infection, particularly among non-Italian immigrants.