Patients with HBV more likely to receive guideline-adherent care if they also have HIV
Click Here to Manage Email Alerts
Patients with hepatitis B virus were more likely to receive guideline-adherent care for their HBV infection if they also had HIV, a study found.
“Traditionally, most HBV patients were taken care of by infectious disease providers, given that HIV and HBV can simultaneously be treated by the same medication regimen in many instances,” Tzu-Hao Lee, MD, assistant professor of hepatology at Baylor College of Medicine, told Healio.
“HBV monoinfected patients typically follow up with gastroenterology/hepatology as the primary treating provider,” Lee said. “Previous studies have shown that the quality of HBV-related care has more gaps in patients with HIV-HBV infection compared to HBV-monoinfected patients.”
This is concerning, Lee said, given that patients with both viruses are also reported to have a higher incidence of liver complications compared with HBV monoinfected patients. However, Lee explained that most of the previous studies on the quality of HBV-related care in patients with HBV and HIV are outdated or were not nationally representative.
“Our team thinks it is vital to have an updated multicenter study to evaluate the quality of HBV-related care in HBV-HIV coinfected patients compared to HBV monoinfected patients,” Lee said. “We also wanted to see if different types of specialty care — ID, GI or no specialty care — play a role here.”
Lee and colleagues retrospectively assessed adherence to care guidelines for HBV among all patients with HBV and HIV coinfection and HBV monoinfection (HBV-M) in the national Veterans Health Administration health care system in 2019.
Overall, they identified 1,021 patients with HBV and HIV coinfection among 8,323 veterans with chronic HBV. They found that adherence to HBV guidelines was similar or better in HBV and HIV coinfected patients compared with HBV-M, including HBV treatment (97% vs. 71%), biannual hepatocellular carcinoma (HCC) surveillance (55% vs. 55%) for patients with cirrhosis, hepatitis A virus screening (69% vs. 56%), hepatitis C screening (100% vs. 99%) and on-therapy alanine aminotransferase monitoring (95% vs. 96%).
The study also demonstrated that, compared with those seeing GI or ID providers, patients without specialty care were less likely to receive antiviral treatment (39% vs. 80% with GI care and 84% with ID care) or HCC surveillance (16% vs. 66% and 47%).
Lee and colleagues said the findings persisted in multivariable analysis. When compared with ID care alone, the study showed that a higher proportion of patients with HBV and HIV seen dually by GI and ID received HCC surveillance (GI and ID: 73% vs. ID: 31%) and on-therapy HBV-DNA monitoring (GI and ID: 82% vs. ID: 68%).
“The quality of HBV-related care is likely to improve further by expanding access to specialty care and investigating and addressing patient- and system-related barriers to care,” Lee said.
Collapse
Read more about
Click Here to Manage Email Alerts