Volume 189 - Issue 4
Preventing primary liver cancer: how well are we faring towards a national hepatitis B strategy?
Authors: Monica C Robotin, Jacob George, Rajah Supramaniam, Freddy Sitas and Andrew G Penman
Med J Aust 2008; 189 (4): 237. || doi: 10.5694/j.1326-5377.2008.tb02004.x
Published online: 18 August 2008
Published online: 18 August 2008
In reply: We agree with Awofeso that prisoners and Indigenous people have an increased risk of developing chronic hepatitis B. However, as no large-scale population-based studies of hepatitis B prevalence have been published in Australia, estimates of the risk vary widely.1 A national hepatitis B strategy may provide additional impetus for obtaining high-quality data. We also concur that modifiable behavioural factors may play a role in the age of hepatocellular carcinoma diagnosis, but differences in clinical course between Asian and white Australians,2 and the specific viral genotypes prevalent in Asia,3 are likely to be more important.
Although white populations who undergo hepatitis B e antigen (HbeAg) seroconversion and develop hepatitis B e antibodies have a good prognosis, this is not so for Asian populations,2 or for other populations who are mostly infected in childhood, such as Indigenous Australians and Māori in New Zealand. The median age of HBeAg seroconversion in Asian patients with chronic hepatitis B is 34.5 years,4 while the median age at diagnosis of hepatocellular carcinoma of Asian patients quoted by Awofeso is 57 years, by which age most would have seroconverted.
Australia has been successful in primary prevention of hepatitis B through vaccination (albeit less so in migrants, some Indigenous communities and catch-up vaccination), and hence the omission of vaccination from our “wish list” for a public health response. However, Australia has been less successful in secondary and tertiary prevention. We hope that a national strategy would be a catalyst for these interventions to be given the priority they deserve.
References
- O’Sullivan BG, Gidding HF, Law M, et al. Estimates of chronic hepatitis B virus infection in Australia, 2000. Aust N Z J Public Health 2004; 28: 212-216. 0_CBBIFHJH
- Yuen MF. Revisiting the natural history of chronic hepatitis B: impact of new concepts on clinical management. J Gastroenterol Hepatol 2007; 22: 973-976. 0_i1091839
- Keeffe EB, Dieterich DT, Han SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update. Clin Gastroenterol Hepatol 2006; 4: 936-962. 0_pgfId-1747945
- Yuen MF, Yuan HJ, Hui CK, et al. A large population study of spontaneous HBeAg seroconversion and acute exacerbation of chronic hepatitis B infection: implications for antiviral therapy. Gut 2003; 52: 416-419. 0_i1091845