Latest news with #chronicHepatitisB
Medscape
13-06-2025
- Health
- Medscape
Most Chronic Hepatitis B Diagnoses in US Are Late
More than 75% of chronic hepatitis B diagnoses in the United States occur late — within 2 years before or after the onset of a liver complication — highlighting the need for improved screening to prevent poor outcomes. METHODOLOGY: Late diagnosis of chronic hepatitis B represents a missed opportunity to intervene early and prevent liver-related complications. Researchers conducted a retrospective analysis of the Truven MarketScan database (2007 to 2021) to estimate the prevalence of late diagnosis of chronic hepatitis B in the US and associated liver complications. Eligible patients had chronic hepatitis B diagnosis and at least 12 months of insurance coverage prior to the first liver complication (cirrhosis, hepatocellular carcinoma [HCC], or liver transplant). A diagnosis was defined as late if it occurred within 2 years before or after the first liver complication, and non-late if was made more than 2 years before the complication. TAKEAWAY: Of 2608 patients included (mean age, 54.83 years; 29.7% women), 76.6% had a late diagnosis of chronic hepatitis B; among these, 44.5% were diagnosed at or within 6 months of their first liver complication, and 75.5% lacked a documented visit to a medical provider prior to their first liver complication. Among those diagnosed > 36 months after the first liver complication, 46% already had another liver disease. Despite treatment advances, the rate of late diagnosis remained stable between 2010 (78.8%) and 2019 (89.3%; P for trend = . 438). for trend 438). Among patients with a late diagnosis, 91.0% had cirrhosis, 81.5% had decompensated cirrhosis, 30.8% developed HCC, and 14.4% underwent liver transplant. Independent predictors of late diagnosis included male sex, alcohol use, and having Preferred Provider Organization (PPO) or Health Maintenance Organization/PPO hybrid insurance. IN PRACTICE: 'Our study suggests that the majority of [hepatitis B virus] diagnoses in the United States are likely incidental from the work-up of a liver complication. These patients can be seen as 'missed opportunities' for treatment and intervention to prevent disease progression and adverse hepatic outcomes,' the authors wrote. SOURCE: This study was led by Michael Le and Joanne K. Liu, Stanford University Medical Center, Stanford, California. It was published online in Alimentary Pharmacology & Therapeutics . LIMITATIONS: This study excluded uninsured individuals and those covered by government insurance (eg, Medicaid), potentially underrepresenting higher-risk populations. Reliance on claims data may have affected the accuracy of diagnosis rates. Data on race, ethnicity, and foreign-born status were unavailable, preventing analysis of these important factors. DISCLOSURES: The authors received no specific funding for this work. No conflicts of interest were disclosed by the authors.
Medscape
02-06-2025
- Business
- Medscape
Metabolic Issues May Affect Liver Fibrosis in Hepatitis B
Patients with untreated chronic hepatitis B who had metabolic comorbidities were at a higher risk for advanced liver fibrosis and were less likely to see improvement with antiviral therapy than those without such comorbidities. METHODOLOGY: Researchers investigated the association between the presence of concurrent metabolic comorbidities and the severity of liver fibrosis in 3179 patients with untreated chronic hepatitis B (median age, 37 years; 72.2% men) using data from two tertiary clinics in the Netherlands and Canada and six global clinical trials. All patients underwent an initial liver biopsy, and 1307 of the patients enrolled in the clinical trials underwent a second biopsy 48-72 weeks after starting antiviral therapy. Biopsies were analyzed by experienced pathologists. Advanced fibrosis was defined as having METAVIR stages F3-F4, and nonadvanced fibrosis as having METAVIR stages F0-F2. Progression or regression of fibrosis was determined by an increase or decrease in fibrosis of at least one METAVIR stage from baseline, respectively. The presence of metabolic comorbidities (overweight, hypertension, diabetes, and dyslipidemia) was assessed using chart reviews and patient histories. TAKEAWAY: At baseline, metabolic comorbidities were present in 54.8% of patients, and advanced fibrosis was present in 24.4% of patients. The presence of metabolic comorbidities was independently associated with an increased risk for advanced fibrosis (adjusted odds ratio [aOR] for one comorbidity, 1.115; aOR for two or more comorbidities, 1.627; P = .006). = .006). The presence of metabolic comorbidities was also independently associated with reduced odds of regression from advanced to nonadvanced fibrosis after initiating antiviral therapy (aOR for one comorbidity, 0.79; aOR for two or more comorbidities, 0.26; P = .025). = .025). Progression to advanced fibrosis during antiviral therapy was observed in 9.8% of patients with one metabolic comorbidity and 14.3% of those with two or more metabolic comorbidities compared with 4.6% of those without metabolic comorbidities ( P = .001). IN PRACTICE: 'These findings provide solid support for the recently published World Health Organization HBV [hepatitis B virus] guideline, which underlines the importance of identifying and managing metabolic comorbidities in CHB [chronic hepatitis B] patients, as these comorbidities increase the risk of fibrosis progression and HCC [hepatocellular carcinoma] development,' the study authors wrote. SOURCE: The study, led by Lisa M. van Velsen, MD, Department of Gastroenterology & Hepatology, Erasmus Medical Center in Rotterdam, the Netherlands, was published online in Clinical Gastroenterology and Hepatology . LIMITATIONS: Information on hepatic steatosis was unavailable for the clinical trial patients. The presence of metabolic comorbidities was determined on the basis of a retrospective review of medical histories and medications, potentially leading to underdiagnosis of the conditions. Changes or development of metabolic comorbidities during follow-up could not be accounted for. DISCLOSURES: This study was sponsored by the Foundation for Liver and Gastrointestinal Research, and the data for the analyses were shared by Roche and Gilead Sciences. Several authors reported receiving research support or grants, consulting and/or speaking fees, honoraria, or contracts from pharmaceutical and biotechnology companies, including Roche and Gilead Sciences. One author reported being employed by Roche, and two authors reported being employed by Gilead Sciences.
