Chronic hepatitis B virus (HBV) infection is a global public health problem, and many regions of Sub-Saharan Africa are disproportionately affected, including Cameroon, where prevalence has previously been shown to be high. This study aimed to provide up-to-date estimates of HBV prevalence in Cameroon. We searched Medline, Global Health, Embase, Web of Science, Cochrane Library, Africa Index Medicus and the Journal of Health Science and Disease at the University of Yaounde. We included studies reporting HBV surface antigen (HBsAg) prevalence in the general population and subpopulations. A random-effects meta-analysis was used to generate pooled estimates of HBsAg prevalence, overall and for population subgroups including those considered at relatively higher-risk and relatively lower-risk of HBV infection. Heterogeneity was assessed using the index of heterogeneity (I[2]). Quality was assessed using the Joanna Briggs Institute critical appraisal tool. Out of 1236 records, 92 papers with 100 studies were included in the meta-analysis. Overall prevalence of HBV in Cameroon was 9.98% (95% confidence interval [CI] 9.00-11.02) with high heterogeneity (I[2] = 98.10%). The prevalences for relatively lower-risk and higher-risk populations were8.94% (95% CI 7.84-10.11) and 12.70% (95% CI 10.28-15.32), respectively. In subgroup analyses, we found that sex, geographical area (regions), population risk groups and study design were the main sources of heterogeneity. Overall, HBV prevalence remains high in Cameroon. Our findings suggest an urgent need for health interventions to halt the spread of the disease, with particular attention needed for males and regions with the highest prevalence.

To close gaps in implementing care of people with hepatitis B virus (HBV) infection in resource-limited settings, we evaluated the accuracy of a novel liver point-of-care ultrasound (POCUS) protocol for hepatitis (PUSH) among front-line non-radiology healthcare workers in Zambia. At University Teaching Hospital in Lusaka, Zambia, from March to June 2024, we trained four nurses and six physicians with experience in HBV management, but not in ultrasound (US), in the PUSH protocol, which includes visualizing the liver in three windows (epigastric, subcostal and right transcostal) to identify cirrhosis-suggestive features and liver lesions suspicious for hepatocellular carcinoma (HCC). Then, consecutive adult participants with chronic hepatitis B (PWHB) alone or HBV/HIV coinfection underwent PUSH with operators blinded to clinical data. We evaluated the accuracy of PUSH for significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard test (RST) and for liver lesions that were possible HCC using a comprehensive abdominal ultrasound by an experienced radiographer as the RST. Nonparametric analysis of the receiver operating curve (ROC) for PUSH was adjusted for operator type (doctor vs. nurse), sex and HIV status. Among 197 PWHBs analysed, 69.5% were taking HBV antivirals and 27.9% had HBV/HIV. According to RSTs, 17.7% of PWHBs had significant fibrosis, 11.6% had cirrhosis and 3.5% had liver lesions. PUSH had low accuracy for significant fibrosis, with sensitivity of 8.3% (17.5-41.4), specificity of 100.0% (96.1-100) and an area under the curve (AUROC) of 0.54 (0.43-0.65), moderate accuracy for cirrhosis, with sensitivity of 60.9% (38.5-80.3), specificity of 97.7% (94.2-99.4) and AUROC of 0.79 (0.69-0.89), and higher accuracy for liver lesions, with 85.7% (42.1-99.6) sensitivity, 98.4% (95.5-99.7) specificity, AUROC of 0.92 (0.78-1.00). After an expedited training, front-line nurses and physicians treating HBV in Zambia were able to use PUSH to diagnose cirrhosis with moderate accuracy and liver lesions with high accuracy, although confidence intervals around performance estimates were wide. Liver POCUS including PUSH may be useful in HBV management when laboratory systems and TE are lacking.

As little is known about the disease burden of chronic hepatitis D virus (HDV) infection, this study examined health-related quality of life (HRQoL) and fatigue at different disease stages. This was a real-world quantitative cross-sectional survey of patients in Germany, Italy, Spain and the USA. Patients were recruited via their treating physicians. Patients who had received bulevirtide for hepatitis B or treatment licensed for HDV were excluded. Of 211 patients, 41% were noncirrhotic (F0-F3); 20% had liver cirrhosis with normal function (compensated); 20% had liver cirrhosis (F4) with impaired function (decompensated); 19% had hepatocellular carcinoma (HCC). Mean (standard deviation; SD) age was 54.5 (11.5) years, 75% were male. ANOVA showed a significant decrease (indicating poorer HRQoL) in EQ-5D-3L visual analogue scale (VAS) scores and index values with worsening disease stage and increasing severity (all p < 0.0001). All domain scores of the Hepatitis Quality of Life Questionnaire v2 (except positive wellbeing) worsened with progressing disease and increasing symptom severity (all p ≤ 0.0001). Mean Fatigue Severity Scale (FSS) total scores also increased, indicating greater fatigue, with worsening of disease and increasing symptom severity (both p < 0.0001). HDV infection significantly impacts patients' HRQoL and fatigue, particularly for patients at later disease stages. Treatments that slow disease progression, reducing the burden of HDV infection, are needed.

Nucleos(t)ide analog (NA) therapy suppresses hepatitis B virus (HBV) DNA, but residual hepatocellular carcinoma (HCC) risk persists. O-glycosylated hepatitis B surface antigen glycan isomer (HBsAgGi) uniquely reflects virion burden. We evaluated the impact of tenofovir alafenamide (TAF) versus entecavir (ETV) on 48-week HBsAgGi kinetics and its utility in stratifying HCC risk in 90 NA-naïve patients (ETV: 73; TAF: 17). A favourable response was defined as a reduction or maintenance of low HBsAgGi levels. TAF independently predicted a favourable response compared with ETV (penalised odds ratio 3.60, p = 0.030). A significant interaction occurred between HBeAg status and HBsAgGi response in relation to HCC development (p = 0.038). In HBeAg-positive patients, a poor response was associated with increased HCC risk (hazard ratio 7.34, 95% confidence interval [CI] 1.96-20.35, p = 0.001); however, the exact magnitude warrants cautious interpretation due to wide CIs. This association was absent in HBeAg-negative cases. Adding HBsAgGi response to the aMAP score improved long-term HCC prediction exclusively in the HBeAg-positive cohort. As the assay targets genotype C-specific O-glycosylation, the findings cannot be generalised to genotypes A, B, or D. In conclusion, on-treatment HBsAgGi response is a specific surrogate marker for stratifying residual HCC risk in HBeAg-positive patients, and TAF is more effective than ETV in inducing these favourable kinetics.

Hepatitis Delta Virus (HDV) infection in HBV-infected individuals is associated with severe clinical outcomes, and screening is recommended in HBsAg-positive patients. We used a rapid lateral flow assay (LFA) to assess anti-HDV antibodies in Brazil, where HDV is highly endemic in the North, while data from the Southeast, particularly São Paulo, remain limited. We conducted a retrospective cross-sectional study to assess anti-HDV antibodies among 46 HBsAg-positive blood donors at Fundação Pró-Sangue/Hemocentro de São Paulo, 381 patients with chronic hepatitis B from the Central Laboratory Division of HC-FMUSP, and 189 individuals from the Hepatology Clinic of HC-FMUSP (101 HIV-infected and 88 chronically HBV-infected). Anti-HDV antibodies were detected using a validated LFA. Positive controls (n = 24) included samples previously confirmed by ELISA and/or PCR, predominantly infected with HDV genotypes 3 and 8. Among 443,400 blood donations, 48 (0.01%) were positive for at least two HBV markers; of these, 46 were tested for HDV, and all were anti-HDV negative. All 381 patients undergoing HBV viral load monitoring were anti-HDV negative, as were all 189 patients receiving hepatology care, including those with HIV coinfection or advanced liver disease. The LFA correctly identified all control samples positive for both anti-HDV antibodies and HDV RNA. The absence of detectable anti-HDV among diverse at-risk populations in São Paulo is consistent with the low endemicity of HDV infection in southeastern Brazil. These findings, together with the assay's high specificity in HDV RNA-positive controls, support its potential utility as a screening tool for HDV infection in low-prevalence settings.

Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains a major challenge in Uganda, where 43% of births occur at home, and access to timely birth dose (BD) vaccination is limited. We evaluated the impact of combining universal three-dose (3D) infant vaccination, targeted BD vaccination, and maternal antiviral treatment for high viral load (HVL) mothers on HBV prevalence among infants. In a prospective 18-month cohort study at five regional maternity hospitals, HIV-negative pregnant women were screened for HBsAg. HBsAg-positive mothers were stratified by HBV DNA into HVL (≥ 20,000 IU/mL), low viral load (LVL), or LVL on treatment. HVL mothers received Tenofovir Disoproxil Fumarate plus Lamivudine in the third trimester. Infants of HBsAg-positive mothers received BD vaccination within 24 h and the 3D pentavalent series; infants of HBsAg-negative mothers received the 3D series only. All infants were tested for HBsAg at nine months. Of 19,053 mothers screened, 3.46% were HBsAg-positive (n = 660). Among HVL mothers (n = 80), 96.3% initiated antivirals; none of their infants who received both BD and 3D tested HBsAg-positive. Among LVL mothers not on treatment (n = 558), the prevalence of infection at nine months was 0.4% despite full vaccination. No infections occurred among LVL mothers on treatment or among infants of HBsAg-negative mothers. Overall infant HBsAg prevalence was 0.19%, with an adjusted national estimate of 0.02%. Integrating maternal antiviral prophylaxis, targeted BD vaccination, and universal 3D vaccination achieved near-elimination of HBV MTCT in this setting. Nationally scaling this strategy could enable Uganda to meet the WHO target of less than 0.1% infant HBV prevalence before 2030 and serve as a model for other high-burden countries with significant rates of home births.

Individuals experiencing stigma related to chronic hepatitis B virus (HBV) infection often experience negative self-beliefs, isolation, discrimination, and reduced willingness to engage with healthcare professionals. We aimed to understand the patient perspective of HBV-related stigma and to summarize the patient experience of stigma in a patient-centric conceptual model. Eligible adult participants with a confirmed diagnosis of chronic HBV infection were recruited from the US, China, and Poland. Qualitative, semi-structured, concept elicitation interviews of approximately 60 min were conducted to explore participants' experiences of stigma. Qualitative analysis of interview data was conducted using Thematic Analysis methods with concepts categorized into domains and pre-determined stigma types. A total of 28 participants were recruited from the US (n = 11), China (n = 11), and Poland (n = 6). Internalized stigma was reported by all participants (n = 28; 100%), social stigma was reported by 79% (n = 22) of participants, and institutional stigma was reported by 57% (n = 16) of participants. Seven domains across condition-specific and health-related quality of life (HRQoL) concepts were identified to create a patient-centric conceptual model of the experience of stigma associated with HBV infection. Each domain was reported by at least half of the participants, with social functioning (n = 28; 100%), emotional wellbeing (n = 27; 96%), and HBV transmission (n = 27; 96%) most frequently reported. Experiences of stigma were highly inter-related. Experiences of HBV-related stigma were highly pervasive, with widespread impact on HRQoL. To address the burden of stigma, reducing internalized stigma would be most impactful as this was the most common and bothersome.

The burden of hepatitis C virus (HCV) infection often falls disproportionately on migrant populations within high-income countries. Differences in health literacy, language, comorbidities, and HCV genotype may influence HCV natural history. 3537 persons including 652 migrants treated for HCV infection with direct-acting antiviral (DAA) (2016-2021) were analysed. We describe the epidemiology of HCV in migrant people compared to Australian-born individuals and examine rates of sustained viral response (SVR), advanced liver fibrosis, cirrhosis, and all-cause mortality. Multivariable logistic and Cox regression analyses examined differences by migrant status. At enrolment, Australian-born patients were younger (mean 51.5 vs. 54.2 years; p < 0.001) and more likely to report injection drug use (p = 0.011), risky alcohol use (p < 0.001), or opioid replacement therapy (p < 0.001). Among migrants, diabetes (13.9% vs. 10.3%; p = 0.008), hepatitis B virus (HBV) exposure (43.3% vs. 29.7%; p < 0.001), active HBV infection (3.1% vs. 1.6%; p = 0.033), and genotypes 4, 5, and 6 (18.3% vs. 6.6%; p < 0.001) was more common. Overall SVR rates were comparable (p = 0.69), but SVR rates among migrants with cirrhosis were lower (88.2% vs. 95.2%; p = 0.002). Advanced fibrosis (24.5%), cirrhosis (35.0%), and five-year survival did not differ by migrant status (all p > 0.05). In migrants, genotype 3 was associated with more advanced liver fibrosis (adj-OR = 1.70, 95% CI 1.40-2.06) and cirrhosis (adj-OR = 1.74, 95% CI 1.48-2.04; p < 0.001), relative to Australian-born patients. Genotypes 2, 4 and 6 HCV were not associated with liver fibrosis and cirrhosis (all p > 0.05). In conclusion, migrants experienced equivalent SVR and rates of liver fibrosis and cirrhosis, and have equivalent or better survival compared to Australian-born patients.

Hepatitis D is common among immigrants in Canada, who account for approximately 23% of the population and tend to originate from high-endemic countries. Mortality rates are notably high among those with chronic infections, and immigrants are less likely to engage in screening and treatment services. This paper aims to assess the cost-utility of screening and treating Hepatitis D Virus (HDV)-positive immigrants in Canada compared with a scenario in which no screening is conducted. This analysis takes a public-payer perspective, uses a lifetime time horizon with a 1.5% annual discount rate, and expresses costs in 2023 Canadian dollars. A state-transition model representing the natural progression of chronic hepatitis B and hepatitis D was developed in TreeAge Pro and mapped onto three interventions: screening and treatment with bulevirtide; screening and treatment with pegylated interferon alfa-2a; and screening and treatment with both bulevirtide and pegylated interferon alfa-2a. The analysis was conducted in accordance with the guidelines of Canada's Drug Agency. The incremental cost-effectiveness ratio (ICER) was estimated for each intervention. Model sensitivity was performed using both univariate and probabilistic sensitivity analyses. All screening and treatment strategies resulted in a reduction in cases of decompensated cirrhosis, hepatocellular carcinoma and liver death, with combination therapy demonstrating the most favourable outcomes. Nevertheless, HDV screening and treatment with pegylated interferon alfa-2a monotherapy was the only cost-effective strategy (ICER: $23,177/QALY). While monotherapy with pegylated interferon alfa-2a proved cost-effective, combination therapy with bulevirtide is likely more clinically effective and may be cost-effective if treatment costs decrease significantly.

Hepatitis B (HBV), hepatitis C (HCV), and HIV remain public health challenges despite effective treatments and preventive options. Infections are often asymptomatic, leading to undiagnosed cases, onward transmission, and preventable morbidity and mortality. In the Netherlands, disease burden is concentrated in specific populations, with many undetected infections. We estimated HBV, HCV, and HIV seroprevalence, identified determinants, and assessed trends over 20 years using data from 14,444 participants aged 15-79 years from three nationwide cross-sectional serosurveys (PIENTER: 1995-1996, 2006-2007, and 2016-2017). Participants completed questionnaires on demographics, behaviour, and socio-economic factors, and serum samples were tested for HBV and HCV in all rounds and HIV in 2017. Seroprevalence estimates were weighted to the Dutch population, trends were analysed using weighted Poisson regression, and determinants were evaluated using multivariable Poisson regression. Weighted HBV seroprevalence remained stable across surveys (3%-5% past or present infection; < 0.4% active infection). HBV prevalence was highest among first-generation migrants, with older age, migration background, and STI history as key determinants. HCV seroprevalence remained low (< 0.4%) and was highest among non-Western migrants. HIV prevalence was 0.1% and highest among non-Western migrants and men who have sex with men. Only 9% of active HBV cases were aware of their status. Overall, HBV, HCV, and HIV seroprevalence remain low in the Netherlands but are concentrated in specific groups with limited awareness. These findings support targeted prevention, screening, and linkage-to-care strategies to achieve the 2030 WHO elimination goals and highlight the importance of continued population-based (sero-)monitoring to guide public health policy.

Interferon-free direct-acting antivirals (DAAs), which are highly effective in eliminating hepatitis C virus (HCV), became available in Japan in 2014. This study aimed to estimate the nationwide socioeconomic outcomes of DAA therapy in Japan using publicly available records, including data from the hepatitis subsidy program and universal healthcare claims between fiscal years 2014 and 2023. Based on the standard dose of each DAA regimen, approximately 300,000 people were estimated to have been treated with DAA therapy by 2023, with a cumulative drug cost of at least 1.23 trillion Japanese yen (10.8 billion United States dollars). The main indication for DAA therapy was the initial treatment of chronic HCV infection without cirrhosis. The estimated cost and number of treated people peaked in 2015, followed by a declining trend. For most DAA regimens, annual prescriptions were the greatest in the same or the following year of approval. Sofosbuvir/ledipasvir and glecaprevir/pibrentasvir were the two most common regimens. The age of people treated with DAA therapy shifted towards younger people during the survey period, particularly in males. While the estimated prevalence of people treated with DAA therapy was higher in Western Japan, the estimated number of treated people and population in each prefecture showed a linear association (p < 0.001). Despite the large economic impact, the rapid uptake of DAA therapy suggests an active program of case finding and treatment with the goal of HCV elimination in Japan. Whereas the demographics of people receiving DAA therapy changed over time, treatments were provided uniformly across the nation.

Low-level residual viremia can be present in chronic hepatitis B (CHB) patients on nucleos(t)ide analogues (NUCs). Due to the detection limits of current HBV DNA assays, the association between residual viremia and HBV-related HCC has not been well studied. This study included NUC-treated HBV-related HCC patients with unquantifiable serum HBV DNA by the conventional Cobas-Taqman assay (< 20 IU/mL) at HCC diagnosis. The HCC patients were matched in a 1:1 ratio with NUC-treated non-HCC controls. Serum samples at the time of HCC diagnosis, 1 year before, and 2 years before diagnosis were retrospectively retrieved and tested for residual viremia by a validated high-sensitivity droplet digital polymerase chain reaction assay (lower limit of detection 1.6 IU/mL). Among 208 patients (104 HCC vs. 104 controls; mean age 63.1, 80.8% male, 54.3% cirrhosis), residual viremia within 2 years was observed in 82.7% of HCC patients and 49.0% of controls (p < 0.001), and was independently associated with HCC occurrence (OR 7.243, 95% CI 1.862-28.170, p = 0.004). In HCC patients, residual viremia was associated with histological microvascular invasion (44.4% vs. 9.1% in patients without residual viremia, p = 0.033) and lower probability of presenting with Barcelona Clinic Liver Cancer stage 0 HCC (OR 0.281, 95% CI 0.094-0.838, p = 0.023). After median follow-up for 7.2 years, residual viremia within 2 years before HCC diagnosis was independently associated with liver-related mortality (HR 4.472, 95% CI 1.212-16.504, p = 0.025). Residual viremia in NUC-treated CHB patients is associated with a higher risk of HCC development, more advanced tumour staging and poorer outcomes. High-sensitivity HBV DNA assays may be utilized for monitoring in NUC treatment.

Directly acting antivirals (DAAs) revolutionised hepatitis C virus (HCV) treatment, offering higher cure rates. We aimed to quantify life expectancy (LE) differences between treated and untreated individuals diagnosed with HCV and assess the contributions of age and causes of death to these differences. We used routine HCV surveillance data linked with UK mortality records. Individuals contributed person-time from age 15 or the earliest HCV diagnosis, whichever was later, and were classified as treated six months post-treatment initiation. The study was divided into two periods: 2015-2018 (Period 1), representing early DAA roll-out targeting advanced liver disease, and 2019-2022 (Period 2). We used non-parametric survival analysis methods and mortality decomposition methods to estimate LE differences, and age- and cause-specific contributions to LE differences. A total of 92,920 individuals contributed 322,570 untreated and 200,581 treated person-years of observation, and 13,294 deaths to the analyses. In Period 1, there was an 8.5-year LE advantage at age 15 for treated females (95% CI: 5.4-11.5) and 8.9 years for treated males (95% CI: 5.6-12.2). In Period 2, this declined to 6.7 (95% CI: 3.3-10.2) and 5.3 (95% CI: 3.0-7.6), respectively. The narrowing gap was driven by rising deaths from suicide, alcohol, and drug misuse in the treated population and corresponding declines in the untreated population. Treated individuals with HCV had consistently higher LE, though the advantage decreased over time. We hypothesise that the early prioritisation of individuals with cirrhosis resulted in a relatively healthier untreated population (i.e., fewer cirrhotic cases) in the later period.

Hepatitis C virus (HCV) infection disproportionately impacts people who inject drugs (PWID). Understanding the prevalence and correlates of current and lifetime HCV infection is necessary to inform prevention, testing and treatment efforts among PWID to reduce HCV burden and achieve HCV elimination targets in this population From June 2021-December 2023, 751 PWID were recruited from syringe service harm reduction programs (SSP) and by referral from communities around New York State (NYS). Participants completed web-based surveys on risk factors and social determinants of health and were tested for HCV antibody and RNA to assess their current and lifetime HCV status (never infected, previously infected, or currently infected). Controlling for recruitment site as a fixed effect, a multivariate mixed logistic regression model was built to assess factors significantly associated with HCV status. Among PWID, 58% had a lifetime history of infection, and 29% were currently infected (50% among those with a lifetime history of infection). Daily/almost-daily injection, opioid injection, homelessness, and experience of abscess (all past-year) were significantly associated with current infection, as was younger age. Past-year SSP utilization was associated with a lifetime history of infection. PWID are a priority population to achieve HCV elimination in NYS. Our findings show that HCV burden is high among PWID utilizing SSPs. Expanding access to HCV care and treatment in harm reduction service settings while also providing services to address social determinants of health may be an effective strategy to progress towards reducing the burden of HCV among PWID.

Current uptake of chronic hepatitis B (CHB) treatment and care in Australia is well below target levels, leading to an ongoing burden of preventable liver disease and cancer. Understanding individual-level trajectories of care engagement and variation by sociodemographic factors is essential to guide efforts to improve access to and retention in care. This study analysed records of hepatitis B viral load (VL) testing and antiviral treatment provided through Australia's national health insurance system, which were linked to migration, death, and sociodemographic data from various government datasets. Treatment and VL testing by population group were assessed, and uptake was calculated using modelled estimates of the number living with CHB. VL testing frequency and treatment adherence based on scripts dispensed were also assessed. Of the estimated 219,800 people living with CHB in Australia in 2023, 118,334 (53.8%) received either VL testing or treatment during 2014-2023. Estimated uptake of VL testing and treatment uptake were lower among Aboriginal and Torres Strait Islander people and also varied by region of birth. Of the 81,360 who received any VL testing, only 17,352 (21.3%) received it regularly, while 31,715 (39.0%) had evidence of prior monitoring but no VL testing since 2019. The majority of those who initiated treatment continued therapy and received supply sufficient for adherence. This study shows that substantial gaps exist in CHB care in Australia, particularly in continued monitoring among those not on treatment. Disparities in uptake are evident by priority population. Re-engaging those lost to follow-up should be prioritised.