Recent studies have disclosed a critical gap in the global management of chronic hepatitis B (HBV), with significant underassessment and undertreatment, especially notable among women and Asian minorities in Western countries. This issue is highlighted in a comprehensive study by Elsevier, which was published in the Journal of Hepatology. Medical practitioners continue to encounter patients presenting with advanced liver disease caused by HBV despite the availability of effective vaccines and oral therapies for those eligible for treatment. This underscores the urgent need for simplified and expanded HBV management protocols to address these shortcomings effectively.
The World Health Organization aims to eliminate viral hepatitis by 2030, a goal that demands immediate action to reduce new infections and fatalities associated with the disease. The findings from this recent study provide crucial data that can help healthcare professionals and policymakers refine strategies to meet this objective, enhancing patient care and health outcomes. Dr. Mindie H. Nguyen, leading the research from Stanford University’s Division of Gastroenterology and Hepatology and Department of Epidemiology and Population Health, conducted an extensive international study. This research examined treatment patterns across a global cohort of HBV patients sourced from academic and specialized referral centres, aiming to improve case-finding guidelines, particularly for primary care providers in resource-limited settings.
The research was conducted as part of the REAL-B consortium, a global collaboration involving 25 study centres across nine countries focused on HBV treatment. It revealed that, among 12,566 patients with chronic HBV, about a quarter needed to be more adequately evaluated for treatment. Only about a third of those who were adequately assessed met the international guidelines for treatment eligibility. Surprisingly, 80-85% of those eligible for treatment received it, highlighting significant gaps in the initial assessment phases.
The study also uncovered significant disparities in the evaluation and treatment processes. Women, though more likely to be adequately evaluated for HBV, were 50% less likely to initiate treatment. In contrast, Asian minorities in Western countries were 40-50% less likely to receive adequate evaluations or start treatments when compared to their counterparts in Eastern regions, suggesting cultural and linguistic barriers as potential underlying causes. This disparity underscores the necessity for tailored approaches in medical practice to address these specific community needs effectively.
Oral antiviral therapy, which includes nucleos(t)ide analogs, has proven to be well-tolerated and lifesaving for chronic HBV patients. However, the real-world data on the utilization of these therapies are scarce, pointing to a need for broader documentation and analysis to understand and address the gaps in treatment application. Dr. Nguyen highlights the critical need to explore ongoing barriers to HBV treatment access, particularly for Asian patients in Western contexts, who face additional challenges, such as language and cultural differences, alongside other socioeconomic factors.
The global burden of HBV remains substantial, affecting an estimated 275 to 316 million people worldwide and contributing to 555,000 deaths in 2019. The disease progression risks are high, with up to one-fifth of affected individuals advancing to cirrhosis and a significant fraction of these developing further complications like hepatic decompensation and hepatocellular carcinoma. This research not only sheds light on the current state of HBV management but also calls for a concerted effort to better understand and mitigate the impact of HBV globally, particularly among high-risk groups. Further studies are essential to evaluate the effect of HBV in other disproportionately affected populations and to enhance treatment protocols universally.
More information: Sahith Kudaravalli et al, Sex and ethnic disparities in hepatitis B evaluation and treatment across the world, Journal of Hepatology. DOI: 10.1016/j.jhep.2024.02.033
Journal information: Journal of Hepatology Provided by Elsevier
