New study explores racial disparity in HBV treatment initiation

Article

The cumulative probabilities of treatment initiation after meeting the criteria was not significantly different between the different racial groups and the incidence of major adverse liver outcomes was 0.1 per 100 person-years and did not differ by race.

A new analysis show African Americans are less likely than other races to meet hepatitis B virus (HBV) treatment criteria.

A team, led by Mandana Khalili, MD, Division of Gastroenterology and Hepatology, University of California, San Francisco, examined whether HBV treatment initiation and outcomes differ among different racial groups.

“There are racial disparities in the prevalence, outcomes, and access to treatment for individuals with chronic hepatitis B,” the authors wrote. “Whether racial discrepancies in outcomes are due to differences in the duration of infection, hepatitis B virus (HBV) genotypes, social determinants of health, or treatment access are unclear.”

The Study

In the multicenter, longitudinal cohort called the Hepatitis B Research Network [HBRN] adult cohort study, the investigators looked at data from hepatitis B surface antigen-positive adults not receiving anti-HBV therapy between January 14, 2011 and January 28, 2018. Each patient was followed up at weeks 12, 24, and every 24 weeks after.

Participants were excluded if they had acute HBV, HIV, hepatitis C, hepatitis D, less than 24 weeks of follow-up after enrollment, initiated treatment at or immediately after enrollment, or had unknown race.

The investigators sought main outcomes of hepatitis B virus treatment initiation and major adverse liver outcomes, including hepatic decompensation, hepatocellular carcinoma, liver transplant, and death.

The study included a total of 1550 participants, 12% (n = 193) of which were African American or Black, 75% (n = 1157) were Asian, 10% (n = 157) were white, and 3% (n = 43) were other races. The median age of the patient population was 41.2 years and sociodemographic and virologic parameters differed between the different groups.

Follow-Up

In the 5727 person-years of follow-up, 504 participants initiated treatment. There was an incident rate of 4.8 per 100 person-years for African American or Black participants, compared to 9.9 per 100 person-years in Asian individuals, 6.6 per 100 person-years in White individuals, and 7.9 per 100 person-years in those of other races (P < .001).

In addition, only 14% of African American or Black participants met the treatment criteria, lower than both Asian (22%) and White (27%) individuals (P = .01).

The cumulative probabilities of treatment initiation after meeting the criteria was not significantly different between the different racial groups. The probability for African American or Black individuals was 0.45 week 48, compared to 0.38 for Asian individuals and 0.40 for White participants. At week 72, the probability was 0.45 for African American or Black individuals, 0.51 for Asian patients, and 0.51 for White participants (P = .68).

In the safety analysis, the incidence of major adverse liver outcomes was 0.1 per 100 person-years. This did not differ by race.

“In this observational study of chronic HBV, African American or Black participants were less likely than individuals of other races to meet treatment criteria, but among those who did, HBV treatment receipt did not differ significantly by race or socioeconomic factors,” the authors wrote. “Not all eligible participants initiated treatment, but adverse liver outcomes were rare. These findings may not be generalizable to patients with chronic HBV receiving care in other settings.”

Mandana Khalili, MD

Credit: University of California, San Francisco

Mandana Khalili, MD

Credit: University of California, San Francisco

This article was published by our sister publication HCP Live.

Reference

Khalili M, Leonard KR, Ghany MG, et al. Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America. JAMA Netw Open. 2023;6(4):e237018. doi:10.1001/jamanetworkopen.2023.7018

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