Shocking data highlights gap in timely antiviral treatment for chronic hepatitis B

Key points:

• Of 2,550 veterans with chronic hepatitis B cirrhosis, only 52% received antiviral treatment.
• Non-Asians, patients with high-risk alcohol use, and patients in rural areas were less likely to receive antiviral treatment.

In an assessment of U.S. veterans with chronic hepatitis B across the country, researchers found that only about half received antiviral treatment, although they identified several potential factors associated with a lack of timely treatment.

“Significant gaps remain in the chronic hepatitis B virus (HBV) cascade of care. In particular, significant gaps and disparities in timely initiation of treatment remain for patients with chronic hepatitis B who are eligible for antiviral therapy.” Robert Huang, MD, MS, A clinical associate professor (affiliated) at the Department of Veterans Affairs Palo Alto Health System and Stanford University School of Medicine told Healio.

“While there are many factors that contribute to low rates of timely antiviral treatment, one potential reason is confusion in timely identification of patients suitable for treatment. However, it is generally accepted that all patients with detectable HBV DNA are associated with chronic HBV All patients with cirrhosis should continue to receive antiviral treatment,” Wong said.

To better understand chronic hepatitis B-related cirrhosis, describe gaps in timely initiation of antiretroviral therapy, and understand whether there are specific predictors of delayed treatment of chronic hepatitis B, Wong and colleagues evaluated a cohort of patients with Chronic hepatitis B cirrhosis in adult veterans. Identification was performed using data from the Department of Veterans Affairs (VA) Corporate Data Warehouse 2010-2022.

According to the study, diagnostic criteria for chronic hepatitis B are at least two positive results for HBsAg, HBV DNA, or HBeAg at least 6 months apart, or at least one positive result for HBsAg, HBV DNA, or HBeAg and an ICD-9/10 code followed by Adjusted multivariable logistic regression models were used to evaluate independent predictors of antiviral treatment for chronic hepatitis B, with the final model based on age, sex, race/ethnicity, HIV status, HCV status, comorbid hypertension, alcohol use, and urban life.

The study included 2,550 adults with chronic HBV cirrhosis, of whom 54.3% were non-Hispanic white, 33.1% were black or African American, 4.8% were Asian, 2.5% were Hispanic, and 0.9% were American Indian or Alaska Native.

Additional baseline data showed that 45.5% had diabetes, 81.9% had hypertension, 22.9% had chronic hepatitis C, 70.2% lived in urban areas, and 12.4% reported alcohol abuse.

Among the entire cohort, only 52% started antiviral treatment.

“This is particularly concerning given that these patients already have advanced liver disease and therefore are at particularly high risk for developing hepatocellular carcinoma or decompensated cirrhosis,” Huang said.

When stratified by race/ethnicity, the study showed that compared with Asians, African Americans (47% vs. 80.5%), non-Hispanic whites (51.3% vs. 80.5%), African Americans (51.3% % vs. 80.5%), Hispanics (64.1% vs. 80.5%), and American Indian/Alaskan Natives (56.5% vs. 80.5%). Additional data show that chronic hepatitis B treatment rates are lower in older patients compared with younger patients. Patients aged 18 to 39 years, and those reporting high-risk drinking versus non-drinking. Those who reported no alcohol consumption.

These results are similar to multivariable regression results, indicating that African American (OR = 0.24; 95% CI, 0.15-0.39), Hispanic patients have greater odds of receiving chronic HBV treatment compared with Asian patients with chronic HBV cirrhosis. Significantly lower (OR = 0.42; 95% CI, 0.21-0.84) and non-Hispanic whites (OR = 0.29; 95% CI, 0.18-0.46) than among high-risk drinkers (OR = 0.32; 95% CI, 0.24 ) -0.42) and rural areas (OR 0.66, 95% CI 0.55-0.79) had significantly lower odds of chronic hepatitis B treatment.

“These alarming data underscore the importance of implementing effective universal HBV screening in accordance with the latest CDC recommendations and providing timely care and appropriate antiviral treatment to patients with chronic hepatitis B,” Wong said.

“Our data, particularly in patients with cirrhosis, highlight the urgent need to ensure that patients with chronic hepatitis B cirrhosis are effectively linked to care and receive guideline-consistent care, including antiviral therapy and hepatocellular carcinoma surveillance.”