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HBV, HCV diagnoses show improved timing in late-stage liver disease

Late diagnosis of hepatitis B and hepatitis C has declined over time among patients with decompensated cirrhosis and those with hepatocellular carcinoma, according to a recently published study. Further, patients with more regular physician visits and lower risk activities were diagnosed earlier.

“Early detection and treatment of HBV and HCV can avert cases of late stage liver disease and improve overall prognosis for patients. ‘Late diagnosis’ of HBV and HCV represents a missed opportunity to reduce risk of liver disease progression and also a potential area that can be targeted for substantive improvement in the realm of hepatitis care,” Hasina Samji, PhD, from the BC Center for Disease Control, British Columbia, and colleagues wrote.

To characterize the timing of HBV and HCV diagnosis relative to the detection of decompensated cirrhosis and HCC, the researchers accessed patient data from the British Columbia Hepatitis Tester’s Cohort. In total, 32,644 patients with HBV and 57,866 patients with HCV met inclusion criteria.

“As hepatitis diagnosis after the appearance of chronic liver disease sequelae is an indicator of sub-optimal screening, identifying groups that are more likely to be diagnosed late can inform targeting of screening programs and health system quality improvement,” the researchers wrote.

The researchers identified late diagnosis of HBV in 383 of 778 patients with decompensated cirrhosis and in 289 of 628 patients with HCC. Of those with decompensated cirrhosis, late diagnosis was more likely among patients born before 1945 (P = .008), those living in an urban setting (P = .008) and those least materially deprived (P = .033). There were no significant factors linked between late diagnosis and HCC among the patients with HBV.

Among the 1,566 of 3,925 patients with late diagnosis of HCV who had decompensated cirrhosis, late diagnosis was more likely among patients born before 1945 (P < .001), those more materially deprived (P < .001), patients with illicit drug use (P < .001) or mental health diagnosis (P = .009), and those who had fewer annual hospital visits (P < .001).

The 283 of 902 patients with late diagnosis of HCV who had HCC were more likely to have been born before 1945 (P = .003), live in an urban setting (P = .04), and have a history of illicit drug use (P = .001) and alcohol use (P = .002).

Late diagnosis decreased in both cases of HBV and HCV. The percentage of HBV cases diagnosed on or after the presentation of decompensated cirrhosis decreased from 92.1% (1992 to 1996) to 25.3% (2007 to 2011). Similarly, the percentage of cases diagnosed with HCC on or after diagnosis of HBV decreased from 90% (1992 to 1996) to 29.4% (2007 to 2011).

For HCV, late diagnosis decreased from 89.5% (1992 to 1996) to 20.4% (2007 to 2011) among those with decompensated cirrhosis and decreased from 85.7% (1992 to 1996) to 21.9% (2007 to 2011) among those with HCC.

“Despite successes in earlier diagnosis over time using risk-based testing, our results identify groups that are being missed for screening such as those who do not see a physician regularly, those who are less visibly at risk and those with serious mental illness; innovative strategies to address these gaps for appropriate secondary prevention and treatment for these groups should be explored,” the researchers concluded. – by Talitha Bennett

Disclosure: Samji reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.