Patients with chronic hepatitis B virus (HBV) infection who received antiviral therapy showed a significant reduction in risk for cirrhosis, hepatocellular carcinoma (HCC), and death, according to the results of a study published in The American Journal of Gastroenterology.
“We were not completely surprised by the reduced risk for cirrhosis observed with HBV antiviral therapy,” said lead author Robert J. Wong, MD, from Veterans Affairs Palo Alto Health Care System in Alameda County, California. “HBV antiviral therapy, through suppression of HBV DNA and normalization of ALT [alanine aminotransferase], has been well known to reduce the long-term risk for HBV-related disease progression and complications.”
“Most of the existing work has focused on risk of liver cancer, showing the HBV antiviral therapy does significantly reduce the risk of developing liver cancer,” Dr. Wong explained. “Our study [results] also emphasized that in patients who have not yet developed cirrhosis, HBV antiviral therapy is associated with reduced risk of developing cirrhosis. This is important in highlighting the need for timely start of therapy in patients who meet current treatment guideline eligibility criteria.”
The researchers analyzed data from 4 safety-net health systems from across the country between 2010 and 2018 to evaluate the effect of HBV treatment on cirrhosis risk, liver-related outcomes, and death among a diverse cohort of 4064 patients that included a large proportion of Black patients.
“Few studies have specifically focused on the benefits of HBV antiviral therapies in non-Asian and noncirrhotic cohorts, especially as it relates to evaluating the impact of treatment on the risk of developing cirrhosis and death,” Dr. Wong and colleagues wrote. “Furthermore, limited studies exist specifically focusing on safety-net and vulnerable populations, cohorts in whom it is particularly important to understand treatment benefits given existing disparities in timely access to HBV therapies and a disproportionately greater burden of advanced liver disease.”
In the patient cohort, more than 51% were women, 42% were younger than 45 years, 32% were Black, 27% were Asian, and 27% were Hispanic. Additionally, 23% received HBV antiviral therapy and 77% did not.
In a propensity score-match cohort, which included 428 patients who received treatment and 428 did not, treatment for chronic HBV was associated with lower risk for cirrhosis (HR, 0.67; 95% CI, 0.46-0.92) and composite cirrhosis, HCC, or death (HR, 0.67; 95% CI, 0.49-0.94). Women had a lower risk for cirrhosis than men, while Black patients had a lower risk than non-Hispanic white patients. After stratifying patients by age, sex, and ethnicity, the investigators found that Asian women younger than 45 years had the greatest benefit from antiviral treatment.
Disparities in Hepatitis B Virus Care
“While not the largest study of Black patients with HBV, our study is unique in not only including a large cohort of Black patients with chronic HBV, but also our focus specifically on safety-net populations, which are some of the most vulnerable patient populations,” Dr. Wong said in an interview. “We are hoping our study along with others highlight the existing disparities in HBV care received so that greater awareness and attention can be focused on improving HBV outcomes among all patients, but particularly the underserved and vulnerable groups that already face significant health care disparities.”
The investigators noted that the analysis “demonstrated significant reductions in risk of liver-related outcomes as a result of HBV antiviral therapies, driven primarily by the decreased risk of incident cirrhosis. Although our study also demonstrated that the antiviral benefit was primarily seen in [chronic HBV] patients who were younger than aged 45 years, female, and of Asian ethnicity, these observations need to be further evaluated in studies with longer follow-up.”
“We hope that these findings will raise greater awareness of the benefits of HBV therapy and prompt greater focus on research and quality improvement programs to achieve effective HBV screening, early diagnosis, and evaluation for treatment among patients with chronic HBV, and ultimately, timely start of antiviral therapy in those meeting treatment eligibility criteria,” Dr. Wong said.
Disclosures: One study author declared affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wong RJ, Jain MK, Therapondos G, et al. Antiviral therapy reduces risk of cirrhosis in noncirrhotic HBV patients among 4 urban safety-net health systems. Am J Gastroenterol. 2021 Mar 1. doi:10.14309/ajg.0000000000001195