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Clinical, epidemiological characteristics and indications for liver biopsy and treatment in immigrants with chronic hepatitis B at a referral hospital in Madrid


José Antonio Pérez-Molina, Tropical Medicine and Clinical Parasitology Unit, Infectious Diseases Department, Ramón y Cajal Hospital, Carretera de Colmenar Km 9,100, Madrid 28034, Spain. E-mail:


Summary.  The increase in immigration from less developed countries to Europe has led to an increase in the incidence of hepatitis B infection. The objective of this study was to describe the clinical, epidemiological characteristics and indications for treatment of chronic hepatitis B in a cohort of immigrants, given the relative lack of current evidence. We performed a noninterventional retrospective chart review; different characteristics depending on geographical origin were compared. A case-control study was also performed to describe factors potentially associated with chronic or past hepatitis B virus (HBV) infection. We selected a random sample of 436 patients out of the 2989 immigrants attending during the study period (1989-2008). Hepatitis B serology was performed in 74% (322/436): 10.6% had chronic HBV infection (95% CI: 7.4–13.7%), and 46.9% had evidence of past infection (95% CI: 41.7–52.0%). The average age was 31 years, 60% were men, and 70% were sub-Saharan Africans. Chronic infection was related to being men (OR 2.03; 95%CI: 1.29–3.18), younger (OR 0.98; 0.96–0.99) and sub-Saharan African (OR 5.41; 2.71–10.83). Past or current infection was related to male sex (OR 2.80; 1.81–4.30), longer time elapsed until first seen at the unit (OR 0.998; 0.997–1.000), HIV infection (OR 4.99; 1.15–21.60) and being sub-Saharan African (OR 15.46; 8.97–27.18). These associations were not confirmed after adjustment for geographical origin. In 27% and 29.5% of patients, liver biopsy and treatment, respectively, would have been indicated. Prevalence of chronic HBV infection amongst immigrants is high, especially in sub-Saharan Africans. Almost a third could be considered for liver biopsy or antiviral therapy.