Skip to main content

Advertisement

SpringerLink
Log in

Rates of Treatment Eligibility in Follow-Up of Patients with Chronic Hepatitis B (CHB) Across Various Clinical Settings Who Were Initially Ineligible at Presentation

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Chronic hepatitis B (CHB) is a major cause of cirrhosis and end-stage liver disease. Not all patients with CHB require antiviral treatment but long-term monitoring is critical to identify patients who would benefit from antiviral therapy. CHB patients followed in various clinical settings may differ in disease characteristics and rates of treatment eligibility in long-term follow-up.

Methods

We conducted a retrospective cohort study of 359 consecutive treatment-naive, treatment-ineligible CHB patients (228 from community GI clinics; 73 from university hepatology clinic; 58 from primary care clinic). Primary end points were the proportion of patients meeting eligibility criteria in follow-up, and the eligibility comparison among patients in various clinical settings. Univariate and multivariate Cox’s proportional hazard models were used to calculate hazard ratios to identify predictors of treatment eligibility in follow-up.

Results

While the majority of patients remained treatment ineligible by guideline recommendations, a sizeable proportion (23 %, 95 % CI 18–27 %) of patients subsequently met treatment eligibility in study follow-up. Reasons for meeting US Panel treatment eligibility on multivariate analysis included baseline ALT ≥ ULN (HR 1.91, p = 0.03) and baseline HBV DNA ≥ 2000 IU/mL (HR 2.6, p = 0.001). Practice setting was not a predictor.

Conclusions

A significant number of patients with CHB (23 %) who were not initially treatment eligible later met treatment criteria in longer-term follow-up. Significant independent predictors of treatment eligibility included a baseline ALT ≥ ULN and elevated HBV DNA (≥2000 IU/mL for US Panel eligibility and ≥20,000 IU/mL for AASLD eligibility). This study underscores the importance of long-term follow-up for patients with CHB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AASLD:

American Association for the Study of Liver Diseases

ALT:

Alanine aminotransferase

CHB:

Chronic hepatitis B

ESLD:

End-stage liver disease

HBeAg:

Hepatitis B e antigen

HBV DNA:

Hepatitis B virus deoxyribonucleic acid

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HDV:

Hepatitis delta virus

HIV:

Human immunodeficiency virus

References

  1. Lok AS. Chronic hepatitis B. N Engl J Med. 2002;346:1682–1683.

    Article  PubMed  Google Scholar 

  2. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR. 2005;54:1–31.

    PubMed  Google Scholar 

  3. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva: World Health Organization; 2015. Available from: http://www.ncbi.nlm.nih.gov/books/NBK305553/.

  4. Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.

    Article  CAS  PubMed  Google Scholar 

  5. Liaw YF, Sung JJ, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351:1521–1531.

    Article  CAS  PubMed  Google Scholar 

  6. McMahon BJ. The natural history of chronic hepatitis B virus infection. Hepatology. 2009;49:S45–S55.

    Article  CAS  PubMed  Google Scholar 

  7. European Association For The Study Of The Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167–185.

    Article  Google Scholar 

  8. Keeffe EB, Dieterich DT, Han SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States 2008 update. Clin Gastroenterol Hepatol. 2008;6:1315–1341. (quiz 1286).

    Article  CAS  PubMed  Google Scholar 

  9. Liaw Y-F, Kao J-H, Piratvisuth T, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int. 2012;6:531–561.

    Article  PubMed  Google Scholar 

  10. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50:661–662.

    Article  PubMed  Google Scholar 

  11. Uribe LA, O’Brien CG, Wong RJ, Gish RR, Tsai N, Nguyen MH. Current treatment guidelines for chronic hepatitis B and their applications. J Clin Gastroenterol. 2014;48:773–783.

    Article  PubMed  Google Scholar 

  12. Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol. 1995;19:1409–1417.

    Article  CAS  PubMed  Google Scholar 

  13. Papatheodoridis GV, Chrysanthos N, Hadziyannis E, Cholongitas E, Manesis EK. Longitudinal changes in serum HBV DNA levels and predictors of progression during the natural course of HBeAg-negative chronic hepatitis B virus infection. J Viral Hepat. 2008;15:434–441.

    Article  CAS  PubMed  Google Scholar 

  14. Bosch FX, Ribes J, Borras J. Epidemiology of primary liver cancer. Semin Liver Dis. 1999;19:271–285.

    Article  CAS  PubMed  Google Scholar 

  15. Degertekin B, Lok AS. Indications for therapy in hepatitis B. Hepatology. 2009;49:S129–S137.

    Article  PubMed  Google Scholar 

  16. Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH. The clinical significance of persistently normal ALT in chronic hepatitis B infection. J Hepatol. 2007;47:760–767.

    Article  CAS  PubMed  Google Scholar 

  17. Nguyen MH, Garcia RT, Trinh HN, et al. Histological disease in Asian-Americans with chronic hepatitis B, high hepatitis B virus DNA, and normal alanine aminotransferase levels. Am J Gastroenterol. 2009;104:2206–2213.

    Article  CAS  PubMed  Google Scholar 

  18. Tong MJ, Hsien C, Hsu L, Sun HE, Blatt LM. Treatment recommendations for chronic hepatitis B: an evaluation of current guidelines based on a natural history study in the United States. Hepatology. 2008;48:1070–1078.

    Article  PubMed  Google Scholar 

  19. Ku KC, Li J, Ha NB, Martin M, Nguyen VG, Nguyen MH. Chronic hepatitis B management based on standard guidelines in community primary care and specialty clinics. Dig Dis Sci. 2013;58:3626–3633.

    Article  PubMed  Google Scholar 

  20. Zhang S, Ristau JT, Trinh HN, Garcia RT, Nguyen HA, Nguyen MH. Undertreatment of Asian chronic hepatitis B patients on the basis of standard guidelines: a community-based study. Dig Dis Sci. 2012;57:1373–1383.

    Article  PubMed  Google Scholar 

  21. Sonneveld MJ, Zoutendijk R, Janssen HL. Hepatitis B surface antigen monitoring and management of chronic hepatitis B. J Viral Hepat. 2011;18:449–457.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of California, San Francisco, CA, USA

    Lindsay A. Uribe

  2. School of Medicine at the University of California, San Diego, CA, USA

    Nghia Nguyen

  3. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA

    Lily Kim & Mindie H. Nguyen

  4. San Jose Gastroenterology, San Jose, CA, USA

    Huy N. Trinh

  5. San Francisco, CA, USA

    Christopher Wong & Clifford Wong

  6. Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA

    Long H. Nguyen

Authors
  1. Lindsay A. Uribe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nghia Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lily Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huy N. Trinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clifford Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Long H. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mindie H. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mindie H. Nguyen.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uribe, L.A., Nguyen, N., Kim, L. et al. Rates of Treatment Eligibility in Follow-Up of Patients with Chronic Hepatitis B (CHB) Across Various Clinical Settings Who Were Initially Ineligible at Presentation. Dig Dis Sci 61, 618–625 (2016). https://doi.org/10.1007/s10620-015-3982-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3982-4

Keywords

Search

Navigation