Undertreatment of Asian Chronic Hepatitis B Patients on the Basis of Standard Guidelines: A Community-Based Study

• Published in: Digestive diseases and sciences Vol. 57; no. 5; pp. 1373 - 1383
• Main Authors: Zhang, Sue, Ristau, Jessica T., Trinh, Huy N., Garcia, Ruel T., Nguyen, Huy A., Nguyen, Mindie H.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.05.2012; Springer; Springer Nature B.V
• Subjects: Adult; Age Factors; Alanine Transaminase - metabolism; Antiviral agents; Antiviral Agents - therapeutic use; Asian Americans; Biochemistry; Care and treatment; Community Health Centers - statistics & numerical data; Data Collection; DNA, Viral - blood; Eligibility Determination - methods; Eligibility Determination - statistics & numerical data; Female; Gastroenterology; Guideline Adherence; Hepatitis B; Hepatitis B virus - drug effects; Hepatitis B virus - genetics; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - ethnology; Hepatitis B, Chronic - metabolism; Hepatitis B, Chronic - virology; Hepatology; Humans; Liver; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Patient Dropouts - statistics & numerical data; Patient Selection; Retrospective Studies; Transplant Surgery; Treatment Refusal - statistics & numerical data; United States - ethnology; United States; Hepatitis B virus; Chronic hepatitis B; Hepatitis B treatment guidelines; Undertreatment; Asian–American
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-012-2137-0

Background and Objectives Previous studies have found that a major proportion of patients with chronic hepatitis B (CHB) do not receive antiviral therapy. The objective of this study was to characterize treatment eligibility on the basis of current guidelines, determine whether eligible patients actually receive treatment, and examine associated predictors. Methods We conducted a retrospective study of patients who were evaluated for CHB at two community gastroenterology clinics between April 2007 and February 2009. Using criteria published by the American Association for the Study of Liver Diseases (AASLD) in 2007–2009 and by a panel of US hepatologists (US Panel) in 2006–2008, treatment eligibility was determined for the patients. Results Of 612 consecutive CHB patients included, mean age was 44 ± 13 years, 54 % were male, and 99 % were Asian. Half (51 %) were eligible for treatment on the basis of the US Panel algorithm and 47 % of these patients also met AASLD treatment criteria. Overall, antiviral therapy was initiated for 50 % of eligible patients: 72 % of AASLD-eligible patients and 29 % of patients who were US Panel-eligible only. Independent predictors for actual treatment initiation were higher ALT for AASLD-eligible patients and higher ALT and older age for patients who were US Panel-eligible only. The leading reasons for nontreatment were further observation recommended by the physician, followed by loss of follow-up and patient refusal. Conclusions Approximately half of the CHB patients evaluated at community referral clinics met treatment criteria of at least one guideline; however, only about half received antiviral therapy within 12 months of presentation. Further studies are needed to optimize treatment of eligible CHB patients.