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A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B
Tanawat Geeratragool1, Pisit Tangkijvanich2,3, Supot Nimanong1
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Insights
A new HePAA score aids in deciding hepatitis B treatment initiation, especially in resource-limited settings. It uses HBeAg, platelets, ALT, and albumin to accurately identify patients needing antiviral therapy.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- International guidelines recommend hepatitis B virus (HBV) antiviral treatment based on viral load, inflammation, or fibrosis.
- These key metrics are often unavailable in resource-limited settings, hindering timely treatment initiation.
- Developing accessible tools is crucial for managing chronic HBV globally.
Purpose of the Study:
- To create and validate a novel, accessible scoring system for initiating antiviral therapy in HBV-infected patients.
- To address the limitations of current diagnostic tools in resource-constrained environments.
- To improve clinical decision-making for chronic hepatitis B management.
Main Methods:
- Regression analysis was used to identify parameters for the scoring system in 602 treatment-naïve patients.
- The novel HePAA score was developed using hepatitis B e-antigen (HBeAg), platelet count, alanine transaminase (ALT), and albumin.
- The score's performance was validated in an independent cohort of 420 patients.
Main Results:
- The HePAA score demonstrated high accuracy (AUROC 0.926 in derivation, 0.872 in validation).
- An optimal cutoff of ≥3 points achieved 84.9% sensitivity and 92.6% specificity.
- HePAA outperformed WHO and REACH-B criteria and was comparable to TREAT-B score.
Conclusions:
- The HePAA scoring system provides a simple and accurate method for determining HBV treatment eligibility.
- It is particularly valuable for resource-limited countries lacking viral load and fibrosis assessment tools.
- This tool can facilitate timely and appropriate antiviral therapy initiation for chronic hepatitis B patients.
Abstract:
Background: International guidelines for hepatitis B infection (HBV) recommend initiating antiviral treatment based on viral replication with inflammation or fibrosis. HBV viral loads and liver fibrosis measurements are not widely available in resource-limited countries. Aim: To develop a novel scoring system for the initiation of antiviral treatment in HBV-infected patients. Methods: We examined 602 and 420 treatment-naïve, HBV mono-infected patients for derivation and validation cohorts. We performed regression analysis to identify parameters associated with the initiation of antiviral treatment based on the European Association for the Study of the Liver (EASL) guidelines. The novel score was developed based on these parameters. Results: The novel score (HePAA) was based on HBeAg (hepatitis B e-antigen), the platelet count, alanine transaminase, and albumin. The HePAA score showed excellent performance, with AUROC values of 0.926 (95% CI, 0.901-0.950) for the derivation cohort and 0.872 (95% CI, 0.833-0.910) for the validation cohort. The optimal cutoff was ≥3 points (sensitivity, 84.9%; specificity, 92.6%). The HePAA score performed better than the World Health Organization (WHO) criteria and the Risk Estimation for HCC in Chronic Hepatitis B (REACH-B) score, and it performed similarly to the Treatment Eligibility in Africa for HBV (TREAT-B) score. Conclusions: The HePAA scoring system is simple and accurate for chronic hepatitis B treatment eligibility in resource-limited countries.
