Digestive Diseases and Sciences

, Volume 59, Issue 9, pp 2091–2099 | Cite as

Low Treatment Rates in Patients Meeting Guideline Criteria in Diverse Practice Settings

  • Lily H. Kim
  • Vincent G. Nguyen
  • Huy N. Trinh
  • Jiayi Li
  • Jian Q. Zhang
  • Mindie H. Nguyen
Original Article


Background and Aims

Data on usage of antiviral therapy and application of chronic hepatitis B (CHB) management guidelines in different settings are limited. Our goal is to evaluate the proportion of treatment-eligible patients by 6-month follow-up and treatment rate among eligible patients by 12-month follow-up in diverse settings.


In this retrospective cohort study, 1,976 treatment-naïve CHB patients were categorized as primary care physician (PCP) group if seen by community PCP (n = 329), gastroenterology (GI) group if seen by community gastroenterologists (n = 1,268), and hepatology group if seen by university hepatologists (n = 379). Treatment eligibility was based on the US Panel 2008 and American Association for the Study of Liver Diseases (AASLD) 2009 guidelines.


All groups had similar age, gender, and ethnic distribution. GI and hepatology groups had similar treatment eligibility rates by US Panel (53–54 %) and AASLD guidelines (24–25 %). However, treatment rate was significantly higher in hepatology compared to GI group by the US Panel guideline (59 vs. 45 %, P = 0.001). PCP group had the lowest eligibility and treatment rates by both guidelines. Common reasons for non-treatment were perceived “normal” alanine aminotransferase, desire for further observation, and patient refusal. Male gender, age >50, and subspecialty care predicted treatment initiation in treatment-eligible patients.


Less than half of treatment-eligible patients at primary care clinics received treatment. Community gastroenterology and university liver clinics treated about one-half to two-thirds of eligible patients. Patient and provider education should highlight treatment benefits and the new alanine aminotransferase upper limit of normal.


Hepatitis B virus Antiviral therapy Treatment guidelines US Panel algorithm AASLD guideline 



American Association for the Study of Liver Diseases


Alanine aminotransferase


Chronic hepatitis B




Hepatitis B e antigen


Hepatitis B virus


Hepatocellular carcinoma


Odds ratio


Primary care physician



Lily H. Kim was supported in part by the Human Biology Program and Undergraduate Academic Life at Stanford University.

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lily H. Kim
    • 1
  • Vincent G. Nguyen
    • 2
  • Huy N. Trinh
    • 2
    • 3
  • Jiayi Li
    • 4
  • Jian Q. Zhang
    • 5
  • Mindie H. Nguyen
    • 1
  1. 1.Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoUSA
  2. 2.Pacific Health FoundationSan JoseUSA
  3. 3.San Jose GastroenterologySan JoseUSA
  4. 4.GastroenterologyPalo Alto Medical FoundationMountain ViewUSA
  5. 5.Chinese HospitalSan FranciscoUSA

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