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Clinical burden, disease progression, and management strategies in chronic hepatitis B: implications for public
1Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Insights
Early antiviral therapy and regular monitoring significantly slow chronic hepatitis B (CHB) progression. Enhancing interventions ensures better management of this global health issue.
Area of Science:
- Hepatology
- Viral Hepatitis
- Public Health
Background:
- Chronic hepatitis B (CHB) presents significant global health challenges due to its progressive nature and long-term complications.
- Real-world data on CHB management are lacking, necessitating longitudinal evidence for effective control strategies.
Purpose of the Study:
- To assess the clinical burden, disease progression, and management of CHB patients in a real-world setting.
- To identify factors influencing CHB progression and treatment outcomes.
Main Methods:
- Retrospective longitudinal cohort study of 520 CHB patients over a mean of 4.1 years.
- Kaplan-Meier analysis for progression-free survival and Cox regression for predictors of disease progression.
- Assessment of clinical burden, disease progression, and management strategies.
Main Results:
- 21.5% had significant fibrosis and 9.8% cirrhosis at baseline. Disease progression occurred in 22.3%, including HCC and liver death.
- Antiviral therapy (46.2% of patients) was linked to high progression-free survival (aHR 0.52).
- Older age, high HBV DNA, baseline fibrosis, elevated ALT, and diabetes predicted progression; undertreatment and unstable monitoring correlated with poor outcomes.
Conclusions:
- CHB imposes a substantial clinical and healthcare burden.
- Early antiviral treatment and regular monitoring are crucial for slowing disease progression.
- Improving population health interventions is vital to bridge the gap between CHB guidelines and clinical practice.
Background:
Chronic hepatitis B (CHB) is one of the most significant global public health issues because it is progressive and has long-term complications, with gaps in real-world management. Longitudinal cohort evidence is required to guide effective disease control strategies.
Objective:
This study aimed to evaluate the clinical burden, disease progression, and management strategies in patients with CHB and to identify factors influencing progression and treatment outcomes in a real-world setting.
Methods:
The study design was a retrospective longitudinal cohort study conducted at a tertiary-care academic referral centre between January 2020 and December 2025. A total of 520 patients were analysed, all of whom were confirmed to have CHB and followed longitudinally through routine clinical care for a mean duration of 4.1 years. Assessment was made on clinical burden, disease progression and management strategies. Kaplan-Meier analyses were used to determine progression-free survival, and multivariable Cox proportional hazards regression was used to determine independent predictors of disease progression.
Findings:
21.5% of patients in the baseline group were found to have significant fibrosis, and 9.8% of the patients had cirrhosis. Follow-up discovered disease evolution in 22.3%, including cirrhosis (11.9%), hepatocellular carcinoma (6.9%), and liver death (5.4%). 46.2% of the patients received antiviral therapy, which was associated with a high rate of progression-free survival. Older age, high levels of HBV DNA, baseline fibrosis, ALT elevation and diabetes mellitus were all independent predictors of disease progression, and antiviral therapy had a very strong protective effect (adjusted HR 0.52, 95% CI 0.36-0.75). It is important to note that almost 20% of eligible patients were not treated, and unstable monitoring was associated with poor clinical outcomes.
Conclusion:
CHB is associated with a significant clinical and healthcare burden. Antiviral interventions and regular observation in the early stages of the disease can greatly slow disease progression, and it is therefore crucial to enhance population health interventions to ensure a smooth transition between the guidelines applied and actual practice.
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