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Hepatitis B Virus Treatment Gaps in the US
Robert J Wong1,2, Laura E Telep3, Charles E Wentworth3
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California.
JAMA Network Open
|November 19, 2025
Summary
Many US patients with hepatitis B virus (HBV) infection who meet treatment criteria are not treated, including those with advanced liver disease. This indicates missed opportunities for preventing severe outcomes like liver cancer.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis B virus (HBV) infection treatment can prevent disease progression, hepatic decompensation, and hepatocellular carcinoma (HCC).
- Previous studies suggested low HBV treatment rates in specific US populations, but national patterns remained unclear.
Purpose of the Study:
- To determine HBV treatment rates among US patients meeting American Association for the Study of Liver Diseases (AASLD) 2016/2018 criteria.
- To identify disparities in treatment by sex and race within this patient cohort.
Main Methods:
- A cross-sectional study analyzed adult patients diagnosed with HBV from April 2016 to December 2022 using the TriNetX Dataworks-USA Network.
- Inclusion criteria required an HBV diagnosis, HBV DNA levels, recent ALT measurements, and continuous database activity, excluding coinfections (HIV, HCV, HDV), HCC, or liver transplant.
- Treatment was defined by anti-HBV medication prescriptions identified via RxNorm codes.
Main Results:
- Of 8,594 eligible patients, only 2,134 (24.8%) received HBV treatment.
- Female patients (12.2%) and Black/African American patients (compared to Asian patients) had significantly lower treatment rates.
- Even among patients with advanced fibrosis or cirrhosis (n=1,310), 40-57% remained untreated.
Conclusions:
- A significant proportion of US patients with HBV infection who meet AASLD treatment guidelines are undertreated.
- Disparities in treatment exist based on sex and race, highlighting potential inequities in care.
- These findings underscore missed opportunities to prevent severe HBV-related liver disease outcomes.
