Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Cori Campbell^{1

2}, Tingyan Wang^{1

2}, David A Smith³, Oliver Freeman^{2

4}, Theresa Noble^{2

3}, Kinga A Várnai^{2

3}, Steve Harris^{2

5}, Hizni Salih², Gail Roadknight², Stephanie Little², Ben Glampson^{6

7}, Luca Mercuri^{6

7}, Dimitri Papadimitriou^{6

7}, Christopher R Jones⁸, Vince Taylor⁹, Afzal Chaudhry⁹, Hang Phan¹⁰, Florina Borca¹⁰, Josune Olza¹⁰, Frazer Warricker¹¹, Luis Romão¹², David Ramlakhan¹², Louise English¹², Paul Klenerman^{1

13}, Monique I Andersson^{13

14}, Jane Collier¹⁵, Eleni Nastouli¹⁶, Salim I Khakoo¹⁷, William Gelson¹⁸, Graham S Cooke^{6

7

19}, Kerrie Woods^{2

3}, Jim Davies^{2

5}, Eleanor Barnes^{1

3}, Philippa C Matthews^{1

3

13}

Affiliations

¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
² NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
³ NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁵ Department of Computer Science, University of Oxford, Oxford, UK.
⁶ NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK.
⁷ NIHR Imperial Biomedical Research Centre, London, UK.
⁸ Department of Infectious Disease, Imperial College London, London, UK.
⁹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁰ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹¹ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹² University College London Hospitals NHS Foundation Trust, London, UK.
¹³ Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹⁴ Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
¹⁵ Department of Hepatology, John Radcliffe Hospital, Oxford, UK.
¹⁶ Department of Clinical Virology, University College London Hospitals NHS Trust, London, UK.
¹⁷ School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁸ Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁹ Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, UK.

PMID: 38721280
PMCID: PMC11077619
DOI: 10.12688/wellcomeopenres.17522.2

Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Cori Campbell et al. Wellcome Open Res. 2023.

. 2023 Nov 15:7:51.

doi: 10.12688/wellcomeopenres.17522.2. eCollection 2022.

Authors

Affiliations

¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
² NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
³ NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁵ Department of Computer Science, University of Oxford, Oxford, UK.
⁶ NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK.
⁷ NIHR Imperial Biomedical Research Centre, London, UK.
⁸ Department of Infectious Disease, Imperial College London, London, UK.
⁹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁰ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹¹ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹² University College London Hospitals NHS Foundation Trust, London, UK.
¹³ Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹⁴ Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
¹⁵ Department of Hepatology, John Radcliffe Hospital, Oxford, UK.
¹⁶ Department of Clinical Virology, University College London Hospitals NHS Trust, London, UK.
¹⁷ School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁸ Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁹ Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, UK.

PMID: 38721280
PMCID: PMC11077619
DOI: 10.12688/wellcomeopenres.17522.2

Abstract

Background: To determine the impact of the COVID-19 pandemic on the population with chronic Hepatitis B virus (HBV) infection under hospital follow-up in the UK, we quantified the coverage and frequency of measurements of biomarkers used for routine surveillance (alanine transferase [ALT] and HBV viral load).

Methods: We used anonymized electronic health record data from the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC) pipeline representing five UK National Health Service (NHS) Trusts.

Results: We report significant reductions in surveillance of both biomarkers during the pandemic compared to pre-COVID-19 years, both in terms of the proportion of patients who had ≥1 measurement annually, and the mean number of measurements per patient.

Conclusions: These results demonstrate the real-time utility of HIC data in monitoring health-care provision, and support interventions to provide catch-up services to minimise the impact of the pandemic. Further investigation is required to determine whether these disruptions will be associated with increased rates of adverse chronic HBV outcomes.

Keywords: COVID-19; HBV; epidemiology; hepatitis B virus; viral hepatitis; virology.

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Conflict of interest statement

Competing interests: GC reports personal fees from Gilead and Merck Sharp & Dohme outside the submitted work. BG reports other from Imperial National Institute for Health Research (NIHR) Biomedical Research Centres (BRC), during the conduct of the study. EN reports grants from ViiV healthcare, grants from GlaxoSmithKline (GSK), grants from Gilead, outside the submitted work. Other authors have no conflict of interest.

Figures

**Figure 1.. Kaplan-Meier plots demonstrating the cumulative proportion of adults with chronic Hepatitis B virus (HBV) infection undergoing routine laboratory surveillance.**
Plots show patients who have had ≥1 alanine transferase (ALT) (panels A, C, E) and ≥1 HBV DNA viral load (VL) (panels B, D, F) measurement each year for pre-COVID-19 (2016–19) and COVID-19 (2020 and part of 2021) years. For both ALT and VL, plots are stratified by treated (panels C and D, respectively) and untreated (panels E and F, respectively) patients. Dashed lines depict median time for 50% of the cohort to have the laboratory assessment undertaken. Cumulative probabilities for each year were calculated using the Kaplan-Meier method, comparing probabilities across years using the log-rank test, with 2016 serving as the reference/baseline year.

**Figure 2.. UK coronavirus disease 2019 (COVID-19) incidence, displayed as number of incident daily COVID-19 cases .**
Data from March 2020 to July 2021 are displayed.

**Figure 3.. Mean numbers of ALT and HBV DNA VL measurements per 100 patients per month during pre-COVID-19coronavirus disease 2019 (COVID-19, 2016–19) and COVID-19 (2020 and part of 2021) periods.**
Data are shown overall and stratified by treatment status for both viral load (VL, panels A, C, E) and alanine transferase (ALT, panels B, D, F). Dates of UK national COVID-19 lockdowns are denoted in overall plots. 95% CIs were calculated using the normal distribution (whereby standard error (SE) is estimated by $\frac{s}{\sqrt{n}}$ with n denoting sample size and s denoting standard deviation).

See this image and copyright information in PMC

References

1. Global Health Sector Strategy on viral hepatitis 2016– 2021.Geneva;2016; [cited 2021 Jun 14]. Reference Source
1. Sarin SK, Kumar M, Lau GK, et al. : Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1–98. 10.1007/s12072-015-9675-4 - DOI - PMC - PubMed
1. Terrault NA, Lok ASF, McMahon BJ, et al. : Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99. 10.1002/hep.29800 - DOI - PMC - PubMed
1. European Association for the Study of the Liver (EASL): EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98. 10.1016/j.jhep.2017.03.021 - DOI - PubMed
1. European Association for the Study of the Liver: The summarized of EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98. - PubMed

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Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Affiliations

Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Medical