Analysis of the Chronic Hepatitis B Care Cascade and Treatment Rates at a Tertiary Medical Center in Southern California

Chronic hepatitis B (CHB) affects the lives of up to 1.89 million people in the United States. The aim of this study was to assess the CHB treatment rates at a tertiary medical system in Los Angeles. We conducted a retrospective analysis of all adult patients with CHB across the entire UCLA database from 2013 to 2023. Based on the ALT and HBV DNA, as well as diagnosis of cirrhosis by ICD-9/10 codes, we determined the number of patients who were eligible for antiviral therapy per AASLD guidelines. Based on this information, we determined the treatment rate of CHB. In the study period, there were 3,384 patients with positive HBsAg. 511 of these patients had HBV-related cirrhosis. Moreover, 429 of 511 cirrhotic patients were on therapy (84%). Of the 2873 non-cirrhotic patients, only 51 patients met treatment criteria per AASLD guidelines. Of these patients, only 37 were started on therapy. However, a total of 1255 patients were on antiviral therapy (37.1%). In addition, 789 (23.3%) patients were on antiviral therapy who did not meet treatment criteria. From 2013 to 2023, the CHB care cascade at UCLA yielded a total treatment rate of 13.8%. Treatment rates of cirrhosis patients were much higher (84.0%). Significantly more patients than were otherwise eligible received treatment. This can potentially be explained by a considerable number of patients being started on treatment prior to being referred to and seen in the UCLA system and/or provider knowledge of treatment thresholds.