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Coffin CS, Ramji A, Cooper CL, Miles D, Doucette KE, Wong P, Tam E, Wong DK, Wong A, Ukabam S, Bailey RJ, Tsoi K, Conway B, Barrett L, Michalak TI, Congly SE, Minuk G, Kaita K, Kelly E, Ko HH, Janssen HLA, Uhanova J, Lethebe BC, Haylock-Jacobs S, Ma MM, Osiowy C, Fung SK. Epidemiologic and clinical features of chronic hepatitis B virus infection in 8 Canadian provinces: a descriptive study by the Canadian HBV Network. CMAJ Open 2019; 7:E610-E617. [PMID: 31641059 PMCID: PMC6813030 DOI: 10.9778/cmajo.20190103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Carla S Coffin
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man.
| | - Alnoor Ramji
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Curtis L Cooper
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - David Miles
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Karen E Doucette
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Philip Wong
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Edward Tam
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - David K Wong
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Alexander Wong
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Sylvester Ukabam
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Robert J Bailey
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Keith Tsoi
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Brian Conway
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Lisa Barrett
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Tomasz I Michalak
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Stephen E Congly
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Gerald Minuk
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Kelly Kaita
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Erin Kelly
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Hin Hin Ko
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Harry L A Janssen
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Julia Uhanova
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Brendan C Lethebe
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Sarah Haylock-Jacobs
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Mang M Ma
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Carla Osiowy
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
| | - Scott K Fung
- Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man
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