HBV infection in Belgium: results of the BASL observatory of 1456 HBsAg carriers.

Introduction : Nationwide studies are mandatory to assess
changes in the epidemiology of HBV infection in Europe.
Aim : To describe epidemiological characteristics of HBsAgpositive
patients, especially inactive carriers, and to evaluate how
practitioners manage HBV patients in real life.
Methods : Belgian physicians were asked to report all chronically
infected HBV patients during a one-year period.
Results : Among 1,456 patients included, 1,035 (71%) were
classified into one of four phases of chronic infection : immune
tolerance (n = 10), HBeAg-positive hepatitis (n = 248), HBeAgnegative
hepatitis (n = 420) and inactive carrier state (n = 357
HBeAg-negative patients with ALT < upper limit of normal (ULN)
and HBV DNA < 2,000 IU/mL). Using less restrictive criteria for
ALT (1-2 ULN) or HBV DNA (2,000-20,000 IU/mL), 93 unclassified
patients were added to the group of inactive carriers. These 93
additional inactive carriers were younger, more frequently males,
with similar risk factors for HBV infection and histological features
compared to inactive carriers according to recent guidelines.
Recent guidelines on management of HBV patients were generally
followed, but systematic HBV DNA measurements and HDV coinfection
screening should be reinforced.
Conclusion : In Belgium, an inactive carrier state was a common
form of chronic HBV infection. Using less restrictive criteria for
classification of inactive carriers did not modify their main characteristics
and seemed better adapted to clinical practice. Recent
guidelines on management of HBV patients should be reinforced.