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Background <p>In the Northern Territory (NT) of Australia, First Nations people with chronic hepatitis B (CHB) are infected with a unique sub-genotype, C4, which contains mutations linked to progressive fibrosis and hepatocellular carcinoma. This cohort study aimed to investigate disease progression in C4 sub-genotype infection and estimate how many untreated individuals may benefit from antiviral therapy with broadening treatment indications.</p> Methods <p>Included individuals were part of Hep B PAST, a co-designed program to improve the cascade of care for people living with CHB in the NT. Disease phase and cirrhotic status were determined algorithmically using clinical and laboratory data at two time points. Loss of HBV antigens was assessed longitudinally. Treatment need was assessed cross-sectionally in the cohort at study completion. Key outcomes were estimated rates of HBsAg/HBeAg loss in sub-genotype C4 infection and quantification of how many untreated individuals qualify for therapy under current Australian and expanded global treatment guidelines.</p> Results <p>HBsAg and HBeAg loss occurred at a rate of 1·04 and 8·06 events/100 person-years respectively (7342·6 and 545·6&#xa0;years follow up). 783 people living with CHB were included (40% female, median age 48&#xa0;years). Of these, 16% had cirrhosis (an additional 6% having FibroScan &gt; 7&#xa0;kPa, meaning 22% had cirrhosis or significant fibrosis) and 25% were prescribed antivirals. Only 6·7% of untreated individuals were treatment eligible under current guidelines. Using the 2024 World Health Organisation guidelines, this increased to 50% due mostly to fibrosis and population prevalence of diabetes.</p> Conclusions <p>Despite advanced liver disease in people living with CHB in the NT, rates of antigen loss in sub-genotype C4 hepatitis B infection are similar to other genotypes. Further work is needed to understand drivers of cirrhosis and significant fibrosis in this population.</p>

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Disease progression & treatment need in sub-genotype C4 hepatitis B infection: a retrospective cohort study in the Northern Territory, Australia

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  • 发表日期：

    2025年7月1日

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  • Genevieve E. Martin,
  • Kelly Hosking,
  • Kelly Banz,
  • Catherine Gargan,
  • Geoff Stewart,
  • Belinda Greenwood-Smith,
  • Penelope Ramsay,
  • Jaclyn Tate-Baker,
  • Christine Connors,
  • Paula Binks,
  • Melita McKinnon,
  • Prashanti Manchikanti,
  • George Garambaka Gurruwiwi,
  • Nicole Allard,
  • Ashleigh Qama,
  • Jessica Michaels,
  • Emily Vintour-Cesar,
  • Robert Batey,
  • Catherine Marshall,
  • Peter Nihill,
  • Tammy-Allyn Fernandes,
  • Karen Fuller,
  • Steven Y. C. Tong,
  • David Boettiger,
  • Benjamin Cowie,
  • Joshua S. Davis,
  • Sarah Mariyalawuy Bukulatjpi,
  • Jane Davies,
  • Anna Ralph,
  • Adrian Miller,
  • Roslyn Dhurrkay,
  • Manoji Gunthilake,
  • Vicki Krause,
  • Lou Sanderson,
  • Phillip Merrdi Wilson,
  • Genevieve Dally,
  • Kerrie Jordan,
  • John Boffa,
  • Alexis Apostolellis,
  • Amanda Dhagapan,
  • Anna Deng,
  • Anngie Everitt,
  • Barbara De Graaff,
  • Brianna Summers,
  • Carrie Fowler,
  • Catherine Blacker,
  • Catherine Stoddart,
  • Charles Pain,
  • Cheryl Ross,
  • David McGuinness,
  • David Reeve,
  • Diane Hampton,
  • Eddie Mulholland,
  • Ella Meumann,
  • Elizabeth Coombes,
  • Emma Childs,
  • Hayden Jose,
  • Hilary Bloomfield,
  • Hugh Heggie,
  • Isabelle Purcell,
  • Jayne Porter,
  • Jyoti Jadeja,
  • Katherine McNamara,
  • Katie McGuire,
  • Keith Forrest,
  • Kelly-Anne Stuart-Carter,
  • Khim Tan,
  • Leanne O’Connor,
  • Lesley Scott,
  • Letisha Murray,
  • Levinia Crooks^,
  • Linda Bunn,
  • Lorraine Johns,
  • Lucie Perrisel,
  • Marco Briceno,
  • Margaret Littlejohn,
  • Maria Scarlett,
  • Marilou Capati,
  • Matthew Maddison,
  • Mikaela Mobsby,
  • Molly Shorthouse,
  • Natasha Tatipata,
  • Nicole Romero,
  • Peter Markey,
  • Phoebe Schroder,
  • Rebecca Katiforis,
  • Robyn Liddle,
  • Rosalind Webby,
  • Richard Sullivan,
  • Sami Stewart,
  • Sandra Nelson,
  • Sean Heffernan,
  • Sean Taylor,
  • Shiraline Wurrawilya,
  • Sinon Cooney,
  • Sonja Hill,
  • Stephen Locarnini,
  • Steven Skov,
  • Su Govindasamy,
  • Sudharsan Venkatesan,
  • Tanya Plavins,
  • Teresa De Santis,
  • Terese Ngurruwuthun,
  • Tiana Alley,
  • Timothy Nabegeyo,
  • Vanessa Towell,
  • Wendy Page

摘要

Background

In the Northern Territory (NT) of Australia, First Nations people with chronic hepatitis B (CHB) are infected with a unique sub-genotype, C4, which contains mutations linked to progressive fibrosis and hepatocellular carcinoma. This cohort study aimed to investigate disease progression in C4 sub-genotype infection and estimate how many untreated individuals may benefit from antiviral therapy with broadening treatment indications.

Methods

Included individuals were part of Hep B PAST, a co-designed program to improve the cascade of care for people living with CHB in the NT. Disease phase and cirrhotic status were determined algorithmically using clinical and laboratory data at two time points. Loss of HBV antigens was assessed longitudinally. Treatment need was assessed cross-sectionally in the cohort at study completion. Key outcomes were estimated rates of HBsAg/HBeAg loss in sub-genotype C4 infection and quantification of how many untreated individuals qualify for therapy under current Australian and expanded global treatment guidelines.

Results

HBsAg and HBeAg loss occurred at a rate of 1·04 and 8·06 events/100 person-years respectively (7342·6 and 545·6 years follow up). 783 people living with CHB were included (40% female, median age 48 years). Of these, 16% had cirrhosis (an additional 6% having FibroScan > 7 kPa, meaning 22% had cirrhosis or significant fibrosis) and 25% were prescribed antivirals. Only 6·7% of untreated individuals were treatment eligible under current guidelines. Using the 2024 World Health Organisation guidelines, this increased to 50% due mostly to fibrosis and population prevalence of diabetes.

Conclusions

Despite advanced liver disease in people living with CHB in the NT, rates of antigen loss in sub-genotype C4 hepatitis B infection are similar to other genotypes. Further work is needed to understand drivers of cirrhosis and significant fibrosis in this population.