Hepatitis B Virus ( <scp>HBV</scp> ) Treatment Eligibility in the <scp>UK</scp> : Retrospective Longitudinal Cohort Data to Explore the Impact of Changes in Clinical Guidelines

Nucleos/tide analogue (NA) drugs are used for long-term treatment of chronic hepatitis B virus (HBV) infection, with treatment eligibility criteria changing rapidly amidst globally evolving clinical guidelines. We aimed to quantify the prescription of NA drugs to date, and to undertake a preliminary assessment of the impact of relaxing treatment eligibility thresholds, leveraging a unique large real-world secondary care dataset. We assimilated longitudinal clinical data, collected between February 1997 and April 2023 from adults with chronic HBV infection from six centres in England through the UK NIHR Health Informatics Collaborative (HIC) Viral Hepatitis and Liver Disease theme. We describe factors currently associated with the receipt of NA treatment and determine the proportion of the population who would become treatment eligible as thresholds change. Across 7558 adults with a mean follow-up of 4.0 years (SD 3.9), NA treatment was prescribed in 2014/7558 (26.6%), and as expected according to guidelines at the time, was associated with HBV e-antigen (HBeAg) positivity and alanine transferase (ALT) above the upper limit of normal (> ULN). Treatment was more likely in males, older adults, in Asian and Other ethnicities (compared to White), and less likely in socioeconomically deprived individuals. The proportion of treatment-eligible individuals was 32.3% based on 2 records of ALT > ULN over 6-12 months, 41.7% based on ALT > ULN and viral load (VL) > 2000 IU/mL, and 95.1% based on detectable VL and either ALT > ULN or age > 30 years. Evolving clinical guidelines will lead to substantial increases in the proportion of individuals living with HBV who are eligible for treatment, underlining the need for services to adapt rapidly to the changing clinical environment.

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Publication Details

Journal
Journal of Viral Hepatitis
Published
2025-10-23
DOI
https://doi.org/10.1111/jvh.70098
Citations
2
Primary Topic
Hepatitis B Virus Studies
Type
article
Field-Weighted Citation Impact
2.71

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article

Hepatitis B Virus ( HBV ) Treatment Eligibility in the UK : Retrospective Longitudinal Cohort Data to Explore the Impact of Changes in Clinical Guidelines

Alexander J. Stockdale, Erik Mayer, William Gelson, Gail Roadknight et al.
2 citations
Journal of Viral Hepatitis
Hepatitis B Virus Studies
2.71
article

Hepatitis B Virus ( HBV ) Treatment Eligibility in the UK : Retrospective Longitudinal Cohort Data to Explore the Impact of Changes in Clinical Guidelines

Alexander J. Stockdale, Erik Mayer, William Gelson, Gail Roadknight, Kinga A. Várnai, Baptiste Briot Ribeyre, Ben Glampson, Stephanie Little, J Jaworski, Salim I. Khakoo, Louise English, Eleanor Barnes, Jim Davies, Hizni Salih, Eleni Nastouli, Timothy K. Roberts, Theresa Noble, Ashley Heinson, Michael George, Philippa Clare Matthews, Ahmed Mohamed Elsharkawy, Florina Borca, Kerrie Woods, Graham Cooke, Tingyan Wang, Cori Campbell, Stacy Todd, Leilei Zhu, Cai Davis, Dimitri Papadimitriou
article en
2 citations

Abstract

Nucleos/tide analogue (NA) drugs are used for long-term treatment of chronic hepatitis B virus (HBV) infection, with treatment eligibility criteria changing rapidly amidst globally evolving clinical guidelines. We aimed to quantify the prescription of NA drugs to date, and to undertake a preliminary assessment of the impact of relaxing treatment eligibility thresholds, leveraging a unique large real-world secondary care dataset. We assimilated longitudinal clinical data, collected between February 1997 and April 2023 from adults with chronic HBV infection from six centres in England through the UK NIHR Health Informatics Collaborative (HIC) Viral Hepatitis and Liver Disease theme. We describe factors currently associated with the receipt of NA treatment and determine the proportion of the population who would become treatment eligible as thresholds change. Across 7558 adults with a mean follow-up of 4.0 years (SD 3.9), NA treatment was prescribed in 2014/7558 (26.6%), and as expected according to guidelines at the time, was associated with HBV e-antigen (HBeAg) positivity and alanine transferase (ALT) above the upper limit of normal (> ULN). Treatment was more likely in males, older adults, in Asian and Other ethnicities (compared to White), and less likely in socioeconomically deprived individuals. The proportion of treatment-eligible individuals was 32.3% based on 2 records of ALT > ULN over 6-12 months, 41.7% based on ALT > ULN and viral load (VL) > 2000 IU/mL, and 95.1% based on detectable VL and either ALT > ULN or age > 30 years. Evolving clinical guidelines will lead to substantial increases in the proportion of individuals living with HBV who are eligible for treatment, underlining the need for services to adapt rapidly to the changing clinical environment.

Journal of Viral HepatitisVol. 32(11)
University College Hospital (GB), University of Liverpool (GB), Imperial College Healthcare NHS Trust (GB), The Francis Crick Institute (GB), Oxford Health NHS Foundation Trust (GB), Cambridge University Hospitals NHS Foundation Trust (GB), Royal Liverpool and Broadgreen University Hospital NHS Trust (GB), Royal Liverpool University Hospital (GB), University Hospital Southampton NHS Foundation Trust (GB), University of Oxford (GB), NIHR Birmingham Liver Biomedical Research Unit (GB), NIHR Imperial Biomedical Research Centre (GB), Department of Virology (FR), UCL Biomedical Research Centre (GB), Oxford BioMedica (United Kingdom) (GB), Oxford University Hospitals NHS Trust (GB), NIHR Birmingham Biomedical Research Centre (GB), Institute of Infection and Immunity (CA), University of Southampton (GB), University College London (GB), Imperial College London (GB)
Francis Crick Institute, National Institute for Health and Care Research, Department of Health and Social Care, University College London, University College London Hospitals NHS Foundation Trust
Openalex Percentile: Top 8%
Hepatitis B Virus Studies
2.71
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