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Gaps in the Cascade of Care Contribute to Poor Liver Cancer Outcomes Among People Living With Hepatitis B: A
Dina Moussa1,2,3, Joan Ericka Flores2,3, Michael Macisaac2
1Burnet Institute, Melbourne, Australia.
Insights
Hepatocellular carcinoma (HCC) in Australia is significantly linked to the hepatitis B virus (HBV). Gaps in antiviral treatment and cirrhosis recognition highlight missed opportunities for prevention and early detection of HBV-related HCC.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Chronic hepatitis B virus (HBV) infection is a primary driver of hepatocellular carcinoma (HCC) globally and in Australia.
- Despite available antiviral therapies, HBV-related HCC remains a significant health concern.
Purpose of the Study:
- To characterize clinical features, HBV care cascade, and outcomes in Victoria, Australia.
- To identify factors influencing antiviral therapy and surveillance uptake in HBV-related HCC patients.
Main Methods:
- Multicenter cohort study of incident HCC cases in Victoria, Australia (2018-2022).
- Retrospective and prospective case identification.
- Analysis of HBV as a cause of HCC, antiviral therapy uptake, surveillance, and survival.
Main Results:
- HBV accounted for 18.2% of 1203 HCC cases; most patients were male and of Asian ethnicity.
- 64% had cirrhosis, with 26% newly diagnosed at HCC presentation.
- Linkage to specialist care significantly improved antiviral treatment uptake (aOR 8.4).
Conclusions:
- HBV remains a substantial cause of HCC in Australia.
- Gaps in antiviral treatment and cirrhosis recognition indicate missed prevention and early detection opportunities.
- Improved linkage to care and HBV management are crucial.
Background:
Chronic hepatitis B virus (HBV) remains a major cause of hepatocellular carcinoma (HCC) in Australia, despite the availability of effective, subsidized antiviral therapy. We aimed to describe the clinical characteristics, HBV care cascade, and outcomes among people with HBV-related HCC in Victoria, Australia.
Methods:
We conducted a multicenter cohort study of all incident HCC cases across eight tertiary health networks in Victoria, Australia. Cases were identified retrospectively (January 1, 2018 to December 31, 2019) and prospectively (January 1, 2020 to October 17, 2022). The primary outcome was the proportion of incident HCC attributable to HBV. Secondary outcomes included uptake of guideline-based antiviral therapy and surveillance and overall survival from HCC diagnosis. Multivariable logistic regression was used to identify factors associated with treatment and surveillance uptake.
Results:
Among 1203 incident HCC cases, 219 (18.2%) were HBV related. Most patients were male (89%) and of Asian ethnicity (60%). While 61% were aged 56-75 years, 25% were 36-55 years. Cirrhosis was present in 141 (64%), although 57 (26%) were newly diagnosed with cirrhosis at HCC presentation. The 121 (60%) patients were eligible for antiviral therapy. Linkage to specialist care was associated with treatment uptake (adjusted OR 8.4, 95% CI 4.3-16.1; p < 0.001). Surveillance enrolment at diagnosis was higher among HBV-related HCC compared with non-HBV HCC (48% vs. 40%).
Conclusion:
HBV remains a substantial contributor to HCC in Australia. Gaps in antiviral treatment and cirrhosis recognition persist, highlighting missed opportunities for prevention and early detection. Interventions to improve linkage to care and delivery of guideline-based HBV management are urgently needed.
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