The diversity and management of chronic hepatitis B virus infections in the United Kingdom: a wake-up call.

BACKGROUND: Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom. METHODS: A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected. RESULTS: Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low. CONCLUSIONS: We demonstrated diversity of chronic HBV infections in UK patients, suggesting that optimal management requires awareness of the variable patterns of chronic HBV in countries of origin. We also found less-than-optimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.

Feasibility and experience of nurse-led ultrasound-guided percutaneous liver biopsy.

The demand for collaborative and innovative clinical practitioners to act as leaders in healthcare remains strong as many challenges are faced including rising costs, shortage of professionals, the introduction of new technology and difficulties with access to care. Nurses in advanced nursing practice are well positioned to respond to this, playing a key role in building nursing knowledge, advancing the nursing profession and contributing to sustainable and effective healthcare systems. Percutaneous liver biopsy (PLB) is an essential tool used for diagnosis and management in liver disease, being most commonly performed by consultant gastroenterologists, hepatologists and radiologists. While invasive and with complications PLB is a simple, cost-effective procedure that can be undertaken at the bedside. Our study demonstrates that an advanced nurse practitioner (ANP) with a sound working knowledge of hepatology and familiarity with indications, methods and risks of PLB procedure can be trained to perform ultrasound-guided liver biopsy both safely and effectively.