Burden of Chronic Hepatitis B in Alberta, Canada

Kochaksaraei, Golasa Samadi

Burden of Chronic Hepatitis B in Alberta, Canada

dc.contributor.advisor	Shaheen, Abdel-Aziz
dc.contributor.advisor	Coffin, Carla S
dc.contributor.author	Kochaksaraei, Golasa Samadi
dc.contributor.committeemember	Barkema, Herman
dc.contributor.committeemember	Seow, Cynthia
dc.date	2023-11
dc.date.accessioned	2023-10-13T20:19:50Z
dc.date.available	2023-10-13T20:19:50Z
dc.date.issued	2023-10-12
dc.description.abstract	Limited recent data exist on chronic hepatitis B (CHB) burden in the North American general population, especially among women of childbearing age (WoCBA). Despite evidence supporting peripartum tenofovir disoproxil fumarate (TDF) prophylaxis in reducing mother-to-child transmission (MTCT), long-term outcomes of untreated and TDF-treated CHB pregnant women are understudied. We aimed to identify the CHB burden in Alberta, Canada, among all ages and WoCBA (18-49 years) and assess clinical outcomes in a multiethnic cohort of CHB patients during pregnancy and postpartum. We retrospectively searched Alberta Analytics administrative databases to describe CHB epidemiology and natural history in all ages and WoCBA between fiscal years 2012-2020. We also examined care linkage among hepatitis B surface antigen (HBsAg)-positive pregnant women during the same period. Furthermore, we collected real-world clinical data during pregnancy and postpartum in women with CHB between 2011-2019. From 2015-2020, the CHB incidence declined to 13.4/100,000 (from 36.4/100,000) for all ages and 18.2/100,000 (from 52.6/100,000) for WoCBA. However, prevalence increased to 210.3/100,000 (from 98.9/100,000) for all ages and 248.6/100,000 (from 131.7/100,000) for WoCBA. CHB patients had lower survival rates than age/sex-matched Canadians (standardized mortality ratios of 3.9 and 5.7 for all ages and WoCBA, respectively). Among 1,927 women (2,436 HBsAg-positive pregnancies) between 2012-2020, 27.6% had recommended hepatitis B-directed assessment during pregnancy and 66.4% of those eligible for antiviral prophylaxis received treatment. In 341 women (446 pregnancies) followed for a median of 33 months postpartum, 19% received TDF (64/341, 53/64 for MTCT prevention). In HBeAg-positive patients (65/341), alanine aminotransferase (ALT) flares were more common, especially in those who stopped TDF postpartum. HBsAg clearance occurred in 2.6% (9/341, 2/9 TDF treated) at a median of 30 months, and 37% (24/65) of hepatitis B e antigen (HBeAg)-positive patients had HBeAg loss at a median of 17 months postpartum. In conclusion, CHB incidence decreased in Alberta among all ages and WoCBA. Our study demonstrates frequent ALT flares, particularly after TDF withdrawal, HBeAg clearance in 37%, and HBsAg loss in 2.9% of patients during long-term postpartum follow-up. The lower survival and suboptimal management of CHB during pregnancy emphasize addressing barriers to guideline recommended HBV care in WoCBA.
dc.identifier.citation	Kochaksaraei, G. S. (2023). Burden of chronic hepatitis B in Alberta, Canada (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/117379
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Hepatitis B
dc.subject	Epidemiology
dc.subject	Incidence
dc.subject	Prevalence
dc.subject	Burden of Disease
dc.subject	Survival
dc.subject	Natural History
dc.subject	Prenatal Transmission
dc.subject	Pregnancy
dc.subject	Women of Childbearng Age
dc.subject	Postpartum
dc.subject	Tenofovir Disoproxil Fumarate
dc.subject	Linkage to Care
dc.subject.classification	Epidemiology
dc.title	Burden of Chronic Hepatitis B in Alberta, Canada
dc.type	doctoral thesis
thesis.degree.discipline	Medicine – Gastrointestinal Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Doctor of Philosophy (PhD)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.