In patients with chronic hepatitis B virus (HBV) infection, treatment evaluation and initiation rates are suboptimal in all practice settings, especially for patients receiving community primary care, according to results of a recent analysis.

The aim of the study was to assess both treatment evaluation as well as treatment initiation rates from various practice settings between January 2002 and December 2016. The study included a total of 4130 treatment-naïve chronic HBV patients located in California who were seen by community primary care physicians (N=616), community gastroenterologists (N=2251), and university hepatologists (N=1263). Eligibility of treatment was evaluated using data obtained during the first 6 months following initial presentation based on criteria from The American Association for the Study of Liver Diseases (AASLD) guidelines, which was adjusted for changes over time.

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“Within the first 6 months of care, the proportions of patients evaluated by all 3 relevant tests (measurements of alanine aminotransferase, hepatitis B virus e-antigen, and HBV DNA) were: 36.69% in community primary care, 59.80% in gastroenterologist care, and 79.97% in hepatology care (P<.0001 among the 3 groups),” the study authors reported. Additionally, only 12.76% of patients in community primary care were found to be eligible for treatment, compared to 24.96% of patients in gastroenterologist care and 29.43% in hepatology care (P<.0001).

The study authors also reported, “Among treatment-eligible patients, there was no significant difference in the proportions of patients who began antiviral therapy between those receiving treatment from a gastroenterologist (55.65%) vs a hepatologist (57.90%; P=.56).” On the other hand, only 31 of the 243 evaluable patients receiving community primary care were found to be eligible for treatment. Of the 31 patients eligible for treatment, only 12 (38.71%) actually received it.

“In an analysis of patients receiving care for chronic HBV infection, we found the proportions evaluated and receiving treatment to be suboptimal, according to AASLD criteria, in all practice settings,” the study authors concluded.


Nguyen VH, et al. Poor adherence to guidelines for treatment of chronic HBV infection at primary care and referral practices. Clinical Gastroenterology and Hepatology. 2018.