Low-cost scoring system informs HBV treatment eligibility in resource-limited countries

SAN DIEGO — A new, low-cost scoring system called TREAT-B accurately determined treatment eligibility for patients with hepatitis B virus, particularly where DNA assays are unavailable, according to research.

“Major international guidelines have recommended the criteria for initiating treatment in patients with chronic hepatitis B infection. However, the hepatitis B DNA assay is not widely accessible and affordable, particularly in low- and middle-income countries. A simple score to indicate hepatitis B treatment eligibility is urgently needed to overcome the barriers for treatment evaluation,” Kessarin Thanapirom, MD, a faculty member in gastroenterology at Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, said at Digestive Disease Week 2022. “TREAT-B is a new simple and low-cost score that has been developed and marketed for hepatitis B treatment eligibility in Africa.”

In a retrospective analysis, Thanapirom and colleagues assessed the validity of the TREAT-B score among 639 treatment-naive patients (mean age, 48.9 years; 50% women) with HBV in Bangkok. Using the AASLD 2018 guideline as the reference standard, researchers compared the performance of the TREAT-B score with the simplified WHO criteria for antiviral therapy patient selection.

TREAT-B scoring was determined by hepatitis B viral protein status (negative = 0 points, positive = 1 point) and alanine transaminase values (<20 U/L = 0 points, 20-39 U/L = 1 point, 40-79 U/L = 2 points and 80 U/L = 3 points). A TREAT-B score greater than or equal to 2 was identified as the treatment threshold in a previous study.

Of the patients analyzed, mean ALT value was 58.1 U/L and 21.4 % of patients were hepatitis B e-antigen positive.

According to study results, 30.7% of patients were eligible for treatment based on the AASLD 2018 guideline, 58.8% were eligible based on WHO criteria and 70.6% were eligible based on TREAT-B score. The TREAT-B score also had an improved area under the receiver operating characteristic curve (AUROC) compared with simplified WHO criteria (AUROC = 0.85; 95% CI, 0.82-0.88 vs. AUROC = 0.63; 95% CI, 0.59-0.68), as well as a sensitivity of 95.9% and specificity of 40.6% for scores of at least 2. Thus, using the TREAT-B cut-off threshold ( 2), antiviral treatment would not have been needed in 59.4% of patients.

Further, applying a greater TREAT-B score ( 3) for HBV therapy patient selection improved the specificity (87.8%) and AUROC (0.8; 95% CI, 0.76-0.84) but reduced sensitivity (71.4%).

“In resource-constrained countries, TREAT-B is a better alternative than the simplified WHO criteria for indicating treatment eligibility,” Thanapirom concluded. “TREAT-B score ( 3) has high accuracy and may reduce the number of patients unnecessarily treated lifelong.”