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Competing Interests: Intérêts concurrents :: Carla Coffin déclare avoir reçu une subvention de recherche de la société GSK. Aucun autre intérêt concurrent n’a été déclaré.

Competing Interests: Competing interests:: Carla Coffin reports research support from GSK. No other competing interests were declared.

Background: Published Canadian epidemiologic data on hepatitis B virus (HBV) infection include single-centre studies or are focused on Indigenous populations. We performed a study to characterize the demographic and clinical features, liver disease status and treatment of people with chronic hepatitis B in Canada., Methods: In this descriptive, opportunistic, cross-sectional study, available data for people known to be monoinfected with HBV were collected by the Canadian HBV Network from existing clinical databases, with support from the National Microbiology Laboratory, Public Health Agency of Canada. Data were collected in all provinces with the exception of New Brunswick and Newfoundland and Labrador. We analyzed the data using parametric and nonparametric statistical methods, with a significance level of p < 0.05., Results: In the 9380 unique patient records reviewed, the median age was 48 years, and 5193 patients (55.4%) were male. Ethnicity information was available for 7858 patients, of whom 5803 (73.8%) were Asian, 916 (11.6%) were black and 914 (11.6%) were white. Most of those tested (5556/6796 [81.8%]) were negative for HBV e-antigen, and most of those with fibrosis data (3481/4260 [81.7%]) had minimal liver fibrosis, with more advanced fibrosis noted in older people (> 40 yr). Of the 980 patients with genotype data, 521 (53.2%) had genotype B or C infection. Most of the 9241 patients with known confirmed treatment status received tenofovir disoproxil fumarate (1655 [17.9%]), lamivudine (1434 [15.5%]) or entecavir (548 [5.9%])., Interpretation: Based on available data, Canadian patients with chronic hepatitis B are predominantly Asian and negative for HBV e-antigen, and have genotype B or C infection. Interprovincial variations were noted in antiviral treatment regimen. This multicentre nationwide study provides data regarding patients with chronic hepatitis B and may inform future studies on the epidemiologic features of HBV infection in Canada., Competing Interests: Competing interests: Carla Coffin reports investigator-initiated research grants/research materials from GlaxoSmithKline, Gilead Sciences, Arbutus Biopharma and Bristol-Myers Squibb, and educational grants from Merck, Gilead Sciences and Janssen Pharmaceutica. She is on the advisory board for Merck, Gilead Sciences and GlaxoSmithKline, and the Trial Guidance and Publication Committee for Spring Bank Pharmaceuticals, and has participated as a local site principal investigator in clinical trials for Gilead Sciences, Spring Bank Pharmaceuticals, Transgene and Janssen Pharmaceutica. Alnoor Ramji reports clinical investigator grants from Allergan, Arbutus Biopharma, Gilead Sciences, Janssen Pharmaceutica, Intercept Pharmaceuticals, Norvartis, Merck, Spring Bank Pharmaceuticals and Assembly Biosciences; personal fees from AbbVie, Gilead Sciences, Intercept Pharmaceuticals, Lupin and Merck; and grants from AbbVie, Celgene Corporation, Gilead Sciences, Janssen Pharmaceutica, Intercept Pharmaceuticals and Merck. Karen Doucette reports a grant from Gilead Sciences. Keith Tsoi reports personal fees from Gilead Sciences, Merck, AbbVie and Intercept Pharmaceuticals, and nonfinancial support from Gilead Sciences. Brian Conway reports grants and honoraria from AbbVie, Gilead Sciences, Indivior, Merck and Viiv Healthcare. He has acted as a consultant for these companies. Lisa Barrett reports grants from AbbVie and personal fees from AbbVie, Bristol-Myers Squibb, Gilead Sciences and ViiV Healthcare. Stephen Congly reports grants from Allergan, Gilead Sciences, Genfit, Boehringer Ingelheim and Bristol-Myers Squibb, and personal fees from Allergan. Edward Tam reports grants from AbbVie, Gilead Sciences, Merck, Intercept Pharmaceuticals and Janssen Pharmaceutica, and personal fees from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Merck, Intercept Pharmaceuticals and Janssen Pharmaceutica. David Wong reports other funding from AbbVie, Merck and Gilead Sciences. Alex Wong reports grants and personal fees from Gilead Sciences. Harry Janssen reports grants from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutica, MedImmune, Merck and Roche, and personal fees from AbbVie, Benitec Biopharma, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutica, MedImmune, Roche, Arbutus Biopharma and Vir Biotechnology. Scott Fung reports speaking and teaching fees from Gilead Sciences and Bristol-Myers Squibb, and consulting fees from Gilead Sciences. No other competing interests were reported., (Copyright 2019, Joule Inc. or its licensors.)

Background: High hepatitis C cure rates have been observed in registration trials with second-generation direct-acting antivirals. Real-world data also indicate high sustained viral response (SVR) rates. Our objective was to determine real-world SVR rates for patients infected with hepatitis C virus (HCV) who were treated with second-generation direct-acting antivirals in the first 18 months of their availability in Canada., Methods: Four centres in Calgary contributed their treatment data for a diverse patient population including those who had or had not undergone liver transplantation, those coinfected with HIV and vulnerable populations. We included all patients documented to have started hepatitis C treatment with direct-acting antivirals between October 2014 and April 2016, with follow-up through October 2016. We used multivariate analysis to determine independent predictors of treatment failure., Results: Outcome data were available for 351 patients, of whom 326 (92.9%) achieved an SVR (193/206 [93.7%], 57/59 [96.6%] and 44/51 [86.3%] for genotypes 1a, 1b and 3, respectively, p = 0.2). Independent predictors of not achieving SVR were older age (adjusted odds ratio [OR] 0.95 [95% confidence interval (CI) 0.90-1.00]), male sex (adjusted OR 0.30 [95% CI 0.10-0.89]) and, in patients with genotype 1a infection, history of hepatocellular carcinoma (adjusted OR 0.13 [95% CI 0.03-0.53]). In the entire cohort, the presence of cirrhosis, genotype and hepatocellular carcinoma were not associated with a lower SVR rate. There were no differences in SVR rate according to treatment centre, HIV coinfection or liver transplantation. Among patients with genotype 3 infection, a significantly lower SVR rate was observed for those treated outside of standard of care than for those treated within standard of care (33.3% v. 89.6%, p = 0.04). De novo hepatocellular carcinoma developed in 12 patients (3.4%) despite successful direct-acting antiviral therapy., Interpretation: We report high SVR rates in a real-world diverse cohort of HCV-infected patients treated with second-generation direct-acting antivirals. The results highlight the importance of conducting real-world analyses to elucidate clinical factors associated with poorer outcomes that may not be identified in registration trials., Competing Interests: Competing interests: See the end of the article., (Copyright 2018, Joule Inc. or its licensors.)

Background: Despite universal vaccination, chronic hepatitis B virus (HBV) infection remains a public health concern in North America owing to immigration. We aimed to characterize the number of people with a positive result of testing for HBV surface antigen (HBsAg) in Calgary, a large urban Canadian health care region, and to assess whether recommended laboratory tests and specialist consultation were done for those identified as HBsAg-positive., Methods: Based on laboratory and Alberta Health Services administrative data, we identified all adults (age > 18 yr) with a positive HBsAg test result from Jan. 1 to Dec. 31, 2014 within the Calgary Zone. Demographic and relevant laboratory data were extracted within 6 months of a positive HBsAg test result, and referral to hepatology (2011-2014) was identified from data on referral to a centralized clinic. Parametric and nonparametric statistical methods were used for analyses., Results: We identified 1214 HBsAg-positive people (584 women [48.1%]; median age 44 [interquartile range (IQR) 36-55] yr). A total of 1192 people (98.2%) had alanine aminotransferase testing (median level 23 [IQR 16-34] U/L; 117 [9.8%] with elevated levels), 682 (56.2%) had testing for HBV DNA (median level 2.8 [IQR 2.1-3.8] logIU/mL), 630 (51.9%) had HBV e antigen testing (negative result in 548 [87.0%]), and 145 (11.9%) had HBV e antibody testing (positive result in 111 [76.6%]). Overall, 144 people (11.9%) received anti-HBV treatment, and 390 (32.1%) were referred to a hepatologist., Interpretation: Many HBsAg-positive people in Calgary did not receive the recommended laboratory assessments. The results highlight the necessity of continual public health efforts to screen for chronic HBV infection in Canada and to ensure adequate follow-up in order to reach the World Health Organization's goal of viral hepatitis elimination by 2030., Competing Interests: Competing interests: See the end of the article., (Copyright 2017, Joule Inc. or its licensors.)