Increasing Treatment Uptake for Chronic Hepatitis B in South America: A Comparative Analysis of Country‐Specific and <scp>WHO</scp> 2024 Guidelines

The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate treatment expansion based on the WHO guidelines. Treatment-naïve CHB patients from Argentina, Brazil, Chile and Uruguay referred to evaluation between January 2010 and June 2024 were retrospectively included. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. A total of 719 patients with CHB, treatment naïve, were included (67.1% male; median age: 50.4 years; HBeAg-positive: 36.3%). The median HBV-DNA level was 43,000 (IQR 633-110,000,000) IU/mL, median ALT was 41 (IQR 23-99) U/L, 47.0% had an APRI > 0.5 and 21.1% had cirrhosis. According to country-specific guidelines, 56.9% (95% CI: 53.2-60.5) met the criteria for treatment. Antiviral treatment was initiated in 84.3% of eligible patients. The proportion of patients meeting treatment criteria under the WHO guidelines increased to 67.3% (95% CI: 63.8-70.6), resulting in a 10.4% (95% CI: 8.1-12.8) increase in treatment candidacy. Treatment expansion was significantly higher in women (15.2%; 95% CI: 10.2-20.1) than in men (8.1%; 95% CI: 5.4-10.7). According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.

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Journal
Journal of Viral Hepatitis
Published
2025-05-26
DOI
https://doi.org/10.1111/jvh.70035
Primary Topic
Hepatitis B Virus Studies
Type
article
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article

Increasing Treatment Uptake for Chronic Hepatitis B in South America: A Comparative Analysis of Country‐Specific and WHO 2024 Guidelines

Victoria Mainardi, Patrícia Momoyo Zitelli, Alexandre de Araújo, Fernando Gruz et al.
Journal of Viral Hepatitis
Hepatitis B Virus Studies
article

Increasing Treatment Uptake for Chronic Hepatitis B in South America: A Comparative Analysis of Country‐Specific and WHO 2024 Guidelines

Victoria Mainardi, Patrícia Momoyo Zitelli, Alexandre de Araújo, Fernando Gruz, Nelia Hernández, Jaime Poníachik, Gabriel Mezzano, Daniela Chiodi, Hugo Cheinquer, Melisa Dirchwolf, Fernando Bessone, Manuel Mendizábal, Ezequiel Ridruejo, Mário Guimarães Pessôa, Sebastián Marciano, Margarita Anders, Diego Hernan Giunta, Alejandro Soza, Fernando Cairo, Daniela Simian, Esteban González Ballerga, Constanza D. Sabate, Gabriel Rifrani, Marcelo Silva, Lucia Navarro, G Vergara, Herman Aguirre, Melina Susana, Luis Rondeau, Carla Enrique, Eugenia Labaronnie, Antonella Olivetti
article en

Abstract

The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate treatment expansion based on the WHO guidelines. Treatment-naïve CHB patients from Argentina, Brazil, Chile and Uruguay referred to evaluation between January 2010 and June 2024 were retrospectively included. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. A total of 719 patients with CHB, treatment naïve, were included (67.1% male; median age: 50.4 years; HBeAg-positive: 36.3%). The median HBV-DNA level was 43,000 (IQR 633-110,000,000) IU/mL, median ALT was 41 (IQR 23-99) U/L, 47.0% had an APRI > 0.5 and 21.1% had cirrhosis. According to country-specific guidelines, 56.9% (95% CI: 53.2-60.5) met the criteria for treatment. Antiviral treatment was initiated in 84.3% of eligible patients. The proportion of patients meeting treatment criteria under the WHO guidelines increased to 67.3% (95% CI: 63.8-70.6), resulting in a 10.4% (95% CI: 8.1-12.8) increase in treatment candidacy. Treatment expansion was significantly higher in women (15.2%; 95% CI: 10.2-20.1) than in men (8.1%; 95% CI: 5.4-10.7). According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.

Journal of Viral HepatitisVol. 32(6)
Pontificia Universidad Católica de Chile (CL), Universidad de Buenos Aires (AR), Hospital Italiano de Buenos Aires (AR), Hospital de Clínicas de Porto Alegre (BR), Hospital del Salvador (CL), Hospital Universitario Austral (AR), Hospital Provincial de Rosario (AR), Hospital de Clínicas "José de San Martín" (AR), Hospital Clínico de la Universidad de Chile (CL), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (AR), Hospital Alemán (AR), Hospital Central de las Fuerzas Armadas (UY), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Hospital El Cruce (AR), Hospital Privado (AR), Hospital de Clínicas (UY)
Good health and well-being
Openalex Percentile: Top 83%
Hepatitis B Virus Studies
DOISourceOpenAlex
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