A hepatitis B expert has called for a paradigm shift in hepatitis B treatment to treat everyone with the disease, rather than relying on guidelines with complex eligibility requirements and tests that only experts can easily interpret.
Part of the reason for expanding treatment is evidence linking hepatitis B infection not only to liver disease but also to hepatocellular carcinoma, the most common form of the disease, said Su Wang, MD, MPH, at the IDWeek 2023 conference in Boston on Thursday. types) are associated with an increased risk. liver cancer. She cited studies showing that hepatitis C is associated with an increased risk of stomach, colorectal and pancreatic cancer, and that persistent infection can lead to “T cell exhaustion” and a weakened immune response.
Wang acknowledged some drawbacks of liberalized treatment, including overtreatment and logistical and cost burdens on patients. However, she said she viewed arguments against making treatment more widely available as “extremely paternalistic” and that providing more treatment staff would elevate patients’ role in decision-making, rather than relying on eligibility algorithms as gatekeepers.
“The patient community wants to be a part of this. Of course there are a lot of people who don’t want to take these drugs, but there are also a lot of people who do but are told they have nothing to worry about,” she said
Wang is the medical director of the Viral Hepatitis Program and Asian Health Center at Cooperman Barnabas Medical Center in Livingston, New Jersey; past president of the World Hepatitis Alliance and senior advisor to the Hepatitis B Foundation.
Several groups have developed guidelines for who should receive hepatitis B treatment. Evidence of cirrhosis is a strong indication for treatment. In the absence of cirrhosis, most guidelines develop a decision tree that includes measurements of viral presence (antigen and DNA) and liver inflammation (alanine aminotransferase (ALT) levels). Current treatments are not curative but can effectively suppress the infection. Oral antiviral drugs are the first choice for initial treatment. These include Baralucu (entecavir), Vemlidy (tenofovir alafenamide) and Viread (tenofovir disoproxil fumarate).
Wang introduced the article published in ” American Journal of Managed Care Data from 2020 showed that 36% of people with hepatitis B received hepatitis B-specific care. The more tests required to qualify for treatment, the less likely a patient will receive treatment, she said.On another slide, Wang showed data for 2021 Journal of Hepatology The results showed that only 65% of patients eligible for treatment according to the American Association for the Study of Liver Diseases guidelines were treated.
Wang said some groups have simplified treatment guidelines. For example, the Hepatitis B Online website maintained by the University of Washington provides a guide for primary care providers that boils eligibility down to measurement of HBV DNA and abnormal ALT levels, and leaves aside HBV antigen measurement for HBV antigen. below any threshold.
Wang mentioned several knock-on effects of liberalizing treatment. Simplified eligibility would open care for hepatitis B patients to non-experts: “We know the harsh reality is that the vast majority of hepatitis B patients in the world do not have access to expert help.” Expanding treatment also means fewer patients, Wang said. People infected with hepatitis B resort to herbal treatments and supplements.
Although she acknowledges the risk of overtreatment, Wang said it happens with other diseases, such as hyperlipidemia.