COMMENTARY

Fine-Tuning Hepatitis B Treatment Strategies

Digestive Disease Week (DDW) 2017

William F. Balistreri, MD

Disclosures

June 28, 2017

Measuring the Risks of Chronic Hepatitis B

Data presented at this year's Digestive Disease Week offer novel insights into the rate of and risk for advanced fibrosis in patients with hepatitis B virus (HBV) infection.

Up to 40% of patients with chronic hepatitis B will develop cirrhosis or cirrhosis-related complications during the course of their disease.[1] Early diagnosis of HBV through effective screening programs allows timely initiation of therapy to prevent disease progression and decompensation. Delays in diagnosis, which may be more common among underserved safety-net populations, contribute to more severe disease at presentation, and thus greater morbidity and mortality.

Wong and colleagues[2] retrospectively evaluated rates and predictors of advanced liver disease (eg, cirrhosis and cirrhosis-related complications) at presentation among adults with chronic HBV. They assessed a cohort of consecutive adults seen in the gastroenterology clinics at a large community-based safety-net hospital system. The prevalence of cirrhosis or cirrhosis-related complications (eg, ascites, variceal bleeding, hepatic encephalopathy, or hepatocellular carcinoma [HCC]) at initial presentation was evaluated and further stratified by sex and race/ethnicity (Asian vs non-Asian).

Among 329 patients with chronic HBV infection, 28% had cirrhosis at initial presentation, 4% had ascites, 4% had variceal bleeding, 5% had encephalopathy, and 4% had HCC. Compared with HBV-infected women, HBV-infected men were more likely to have cirrhosis (35% vs 19%; P < .01) and variceal bleeding (5.6% vs 1.4%; P < .05) at initial presentation. No significant race/ethnicity-specific differences were observed in rates of cirrhosis or cirrhosis-related complications at presentation. HBV-infected patients with concurrent nonalcoholic fatty liver disease demonstrated a trend toward higher rates of cirrhosis at initial presentation (33% vs 25%; P value nonsignificant).

Thus, among adults with chronic HBV at an ethnically diverse safety-net hospital system, nearly 30% of patients had cirrhosis at initial presentation, with the greatest risk seen among males and patients with concurrent nonalcoholic fatty liver disease.

The investigators urged an enhancement of efforts to diagnose and treat this population, including development of patient awareness programs, adherence to testing and follow-up strategies, and improved communication with and access to patients.

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