Sa1488 - Adherence to Aasld Treatment Guidelines on Treatment Initiation Among Treatment-Eligible Patients with Chronic Hepatitis B: Experiences from Primary Care and Referral Practices

Background and Aims:The American Association for the Study of Liver Diseases (AASLD) treatment guidelines for chronic hepatitis B (CHB) patients have changed over time.We aimed to assess the rate of optimal evaluation, treatment eligibility, and treatment initiation for CHB patients in various practice settings in the United States (US).Method: This was a retrospective cohort study of 4130 consecutive, treatment-naïve patients with CHB by community primary care physicians (PCP) (n=616), community gastroenterologists (GI) (n= 2251), and university hepatologists (n=1263) from January 2002 to December 2016.Eligibility was defined by the AASLD criteria and adjusted based on changes over time of the criteria for three lab tests: alanine aminotransferase (ALT), hepatitis B e antigen (HBeAg), and hepatitis B virus (HBV) DNA.Eligibility was assessed in the first 6 months of followup.Eligible patients were treated if they were on treatment by 12-month follow-up.The follow-up period was up to 5 years.Results: By 6-month follow-up, 36.69% of patients had all three lab tests in PCP group, 59.80% in GI, and 79.97% in hepatology (p<0.0001).All three groups had low eligibility rates:12.76% in PCP group, 24.96% in GI, and 29.43% in hepatology (p<0.0001).Treatment rates were 38.71% in PCP group, 55.65% in GI, and 57.90% in hepatology (p<0.0001).Being male (OR: 1.40, 95% CI: 1.09-1.79,p=0.008); referral to hepatologists (OR: 2.58, 95% CI: 1.45-4.59,p=0.001); and having positive HBeAg (OR: 1.87, 95% CI: 1.14-3.05,p=0.013) were the strongest predictors for treatment initiation.Of 3018 CHB patients who were initially treatment-ineligible, 8.98% became eligible in PCP group, 22.95% in GI, and 14.14% in hepatology (p<0.0001).Of these patients, hepatology had the highest treatment rate of 81.97%, followed by GI with 61.54%, and lowest in PCP group with 23.91% (p<0.0001).The strongest predictors for treatment initiation were male gender (HR:1.42,95% CI 1.06 -1.90, p=0.017); referral to community GI (HR: 3.03, 95% CI: 1.11 -8.24 p=0.03); and having an elevated HBV DNA level (HR: 1.17, 95% CI: 1.04 -1.20, p=0.004).Cumulative incidence of treatment initiation via Kaplan-Meier methods showed higher treatment initiation in GI and hepatology group compared to PCP group in follow-up period (p=0.006).Conclusion: The overall treatment rates by 12-month followup after diagnosis and in long-term follow-up were significantly low for treatment-eligible patients seen by primary care physicians.