The percentage of patients with chronic hepatitis B virus (HBV) infection undergoing evaluation and receiving treatment according to criteria established by the American Association for the Study of Liver Diseases (AASLD) has been found to be suboptimal, according to a study published in Clinical Gastroenterology and Hepatology.

A group of investigators conducted a retrospective, multicenter study to determine patient evaluation and treatment initiation practices in varying clinical settings and compare these findings with the AASLD guidelines. Treatment rates were measured from 2002 to 2016.

A total of 4130 treatment-naive patients with chronic HBV infection who visited community primary care physicians (n = 616), community gastroenterologists (n = 2251), or university hepatologists (n = 1263) were included in analysis. Relevant tests for chronic HBV infection included alanine aminotransferase, hepatitis B virus e-antigen, and HBV DNA.

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The investigators reported that 36.69% of the primary care patients, 59.80% of the gastroenterologist care patients, and 79.97% of hepatology care patients underwent relevant testing within the first 6 months of receiving care.

For primary care, gastroenterologist care, and hepatologist care, the proportion of patients eligible for treatment in specialty practices was 12.76%, 24.96%, and 29.43%, respectively. For treatment-eligible patients receiving treatment from a gastroenterologist or a hepatologist, no significant difference was noted in the proportion of individuals beginning antiviral therapy (55.65% vs 57.90%, respectively): Of the 243 evaluable patients from the primary care cohort, 31 were eligible for treatment and only 12 received treatment (38.71%). 

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“Such findings suggest that there remains a lack of knowledge on the availability and effectiveness of [chronic HBV] treatment, likely both at provider and patient levels,” the authors noted. “Therefore, efforts should be directed towards educating all practitioners and patients on the availability of treatment guidelines which includes appropriate [chronic HBV] evaluation and effective antiviral therapies which is especially important for [chronic HBV] highly prevalent communities. We also advocate for more active intervention such as standardized evaluation template, reminder/recall system, and a referral process that can enhance adherence to practice guidelines such that all patients identified with a positive HBsAg would be referred for posttest counseling and optimal hepatitis B-directed care.”


Nguyen VH, Le AK, Trinh HN, et al. Poor adherence to guidelines for treatment of chronic HBV infection at primary care and referral practices [published online October 13, 2018]. Clin Gastroenterol Hepatol. doi: 10.1016j.cgh.2018.10.012