Abstract

A substantial number of patients who do not meet treatment criteria for chronic hepatitis B later develop adverse outcomes such as cirrhosis and hepatocellular carcinoma (HCC). Our aim was to determine whether current practice guidelines adequately identify chronic hepatitis B (CHB) patients who will benefit from antiviral therapy.We performed a retrospective cohort study comparing the incidence of adverse liver outcomes (cirrhosis and/or HCC) in untreated treatment-ineligible (at baseline and throughout follow-up) versus treated treatment-eligible patients according to standard AASLD 2018 guidance (ALT [U/L] > 70/50 for men/women plus HBV DNA [IU/mL] > 20,000/2,000 for HBeAg+/-) and with a sensitivity analyses using a lower threshold (ALT > 40 U/L and HBV DNA > 2,000 IU/mL).We reviewed records of 5,840 patients from 5 clinics in California and identified 2,987 treatment-naïve non-HCC CHB patients. Of those, 271 patients remained untreated treatment-ineligible, 514 patients were treatment-eligible and initiated treatment, with 5-year cumulative adverse liver incidences of 12.5% vs 7.2%, P=0.074. On multivariable analysis adjusting for age, sex, diabetes, albumin, platelet count and HBV DNA, compared to treated treatment-eligible patients, untreated treatment-ineligible patients had a significantly higher risk of adverse liver outcomes (adjusted HR: 2.38, 95% CI 1.03-5.48, P=0.04) in main analysis by AASLD 2018 criteria, but not in sensitivity analysis using the lower treatment threshold (P=0.09).Patients never meeting standard AASLD 2018 criteria for antiviral therapy and never treated had twice the risk of developing cirrhosis and/or HCC when compared to eligible and treated patients.

View details for DOI 10.1159/000526933

View details for PubMedID 36070707