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Abstract Details
Antiviral Therapy Reduces Risk of Cirrhosis in Noncirrhotic HBV Patients Among 4 Urban Safety-Net Health Systems
Am J Gastroenterol. 2021 Jul 1;116(7):1465-1475. doi: 10.14309/ajg.0000000000001195.
Robert J Wong123, Mamta K Jain45, George Therapondos6, Bolin Niu7, Onkar Kshirsagar8, Mae Thamer8
Author information
1Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.
2Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
3Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, California, USA.
4Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
5Parkland Health and Hospital System, Dallas, Texas, USA.
6Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, Louisiana, USA.
7Division of Gastroenterology and Hepatology, MetroHealth System, Cleveland, Ohio, USA.
8Medical Technology and Practice Patterns Institute, Bethesda, Maryland, USA.
Abstract
Introduction: To evaluate the impact of chronic hepatitis B virus infection (CHB) treatment on risk of cirrhosis, liver-related outcomes, and death among a diverse CHB cohort with a large proportion of African Americans.
Methods: Adults with noncirrhotic CHB without human immunodeficiency virus from 2010 to 2018 were retrospectively evaluated across 4 US safety-net health systems. CHB was identified with International Classification of Diseases, Ninth Revision/Tenth Revision diagnosis coding and confirmatory laboratory data. Propensity-score matching, Kaplan-Meier methods, and adjusted Cox proportional hazards models were used to evaluate impact of CHB treatment on risk of cirrhosis, hepatocellular carcinoma (HCC), death, and composite of cirrhosis, HCC, or death.
Results: Among 4,064 CHB patients (51.9% female, 42.0% age <45 years, 31.6% African American, 26.6% Asian, 26.7% Hispanic), 23.2% received CHB antiviral therapy and 76.8% did not. Among the propensity score-matched cohort (428 treated and 428 untreated), CHB treatment was associated with lower risk of cirrhosis (hazards ratio 0.65, 95% confidence interval 0.46-0.92, P = 0.015) and composite of cirrhosis, HCC, or death (hazards ratio 0.67, 95% confidence interval 0.49-0.94, P = 0.023). Females vs males and African Americans vs non-Hispanic whites had significantly lower risk of cirrhosis. When treatment effects were stratified by age, sex, and ethnicity, the benefits of antiviral therapies in reducing risk of cirrhosis were seen primarily in CHB patients who were females, age <45 years, and of Asian ethnicity.
Discussion: Our propensity score-matched cohort of noncirrhotic CHB patients demonstrated significant reductions in risk of cirrhosis due to CHB treatment.