Alarming data highlight gaps in timely antiviral therapy for chronic HBV
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Key takeaways:
- Among 2,550 veterans with chronic HBV cirrhosis, only 52% were on antiviral therapy.
- Non-Asians, patients with high-risk alcohol use and those in rural settings had lower odds of receiving antiviral therapy.
After assessing a national cohort of U.S. veterans with chronic hepatitis B, researchers found that only about half were on antiviral therapy, although they identified some potential factors associated with lack of timely treatment.
“Major gaps in the chronic hepatitis B virus (HBV) cascade of care persist. In particular, there remains major gaps and disparities in timely initiation of treatment for chronic HBV patients that are eligible for antiviral therapy,” Robert J. Wong, MD, MS, clinical associate professor (affiliated) at Veterans Affairs Palo Alto Healthcare System and Stanford University School of Medicine, told Healio.
“While there are many factors contributing to low rates of timely antiviral therapy, one potential reason is confusion in timely identification of patients that are eligible for therapy. However, it is generally accepted that all patients with chronic HBV-related cirrhosis with detectable HBV DNA should remain on antiviral therapy,” Wong said.
In an effort to better understand chronic HBV-related cirrhosis, describe gaps in timely ART initiation and understand whether there are specific predictors that predispose to delays in chronic HBV treatment, Wong and colleagues assessed a cohort of adult veterans with chronic hepatitis B cirrhosis who they identified using data from the 2010-2022 Veterans Affairs (VA) Corporate Data Warehouse.
According to the study, chronic HBV was identified by 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 one ICD-9/10 code for chronic hepatitis B. Adjusted multivariable logistic regression models were then used to evaluate for independent predictors of chronic HBV antiviral treatment, with the final model being adjusted for age, sex, race/ethnicity, HIV status, hepatitis C virus status, comorbid hypertension, alcohol use and urbanicity.
Among 2,550 adults with chronic HBV cirrhosis included in the study, 54.3% were non-Hispanic white, 33.1% were black or African American, 4.8% Asian, 2.5% Hispanic and 0.9% American Indian or Alaska Native.
Additional baseline data showed that 45.5% had diabetes, 81.9% had hypertension and 22.9% had concurrent chronic HCV, 70.2% lived in urban areas and 12.4% reported heavy alcohol use.
Of the entire cohort, only 52% were started on antiviral therapy.
“This is particularly concerning given that these patients have already developed advanced liver disease and thus are at an especially higher risk of developing hepatocellular carcinoma or decompensated cirrhosis,” Wong said.
When stratified by race/ethnicity, the study showed that compared with Asians, there were significantly lower rates of chronic HBV treatment among in African Americans (47% vs. 80.5%), non-Hispanic whites (51.3% vs. 80.5%), Hispanics (64.1% vs. 80.5%) and American Indian/Alaska Natives (56.5% vs. 80.5%). Additional data showed lower rates of chronic HBV treatment among older patients vs. patients aged 18 to 39 years, as well as among patients reporting high-risk alcohol use vs. those reporting no alcohol use.
These results were similar to those found on multivariate regression, which showed that compared with Asian patients with chronic HBV cirrhosis, there were significantly lower odds of chronic HBV treatment among African Americans (OR = 0.24; 95% CI, 0.15-0.39), Hispanics (OR = 0.42; 95% CI, 0.21-0.84) and non-Hispanic whites (OR = 0.29; 95% CI, 0.18-0.46), whereas patients with high-risk alcohol use (OR = 0.32; 95% CI, 0.24-0.42) and those in rural areas (OR 0.66, 95% CI 0.55-0.79) had significantly lower odds of chronic hepatitis B treatment.
“These alarming data emphasize the importance of implementing effective universal HBV screening that aligns with updated recommendations from the CDC, and timely linkage to care and appropriate antiviral treatment for those with chronic hepatitis B,” Wong said.
“Our data, specifically in those with cirrhosis, emphasizes the urgent need to ensure that patients with chronic hepatitis B cirrhosis in particular are effectively linked to care and are receiving guideline concordant care, including antiviral therapy and also surveillance for hepatocellular carcinoma.”
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