Increasing Treatment Uptake for Chronic Hepatitis B in South America: A Comparative Analysis of Country-Specific and WHO 2024 Guidelines
Corresponding Author
Manuel Mendizabal
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Correspondence:
Manuel Mendizabal ([email protected])
Search for more papers by this authorConstanza D. Sabate
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Search for more papers by this authorEsteban González Ballerga
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorFernando Gruz
Inmunología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorEzequiel Ridruejo
Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorAlejandro Soza
Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
Search for more papers by this authorJaime Poniachik
Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
Search for more papers by this authorGrace Vergara
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorVictoria Mainardi
Programa Nacional de Trasplante Hepático y Servicio de Hepatología, Hospital Central de Las Fuerzas Armadas, Montevideo, Uruguay
Search for more papers by this authorGabriel Mezzano
Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
Search for more papers by this authorFernando Bessone
Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, Universidad de Rosario, Rosario, Argentina
Search for more papers by this authorMargarita Anders
Unidad de Hígado y Trasplante Hepático, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorMario G. Pessoa
Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorFernando Cairo
Trasplante Hepático, Hospital El Cruce, Florencio Varela, Argentina
Search for more papers by this authorDaniela Chiodi
Unidad Asistencial Gastroenterología, Facultad de Medicina, Hospital de Clínicas, UdelaR, Montevideo, Uruguay
Search for more papers by this authorMelisa Dirchwolf
Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina
Search for more papers by this authorHugo Cheinquer
Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Search for more papers by this authorMelina Susana
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorLuis Rondeau
Programa Nacional de Trasplante Hepático y Servicio de Hepatología, Hospital Central de Las Fuerzas Armadas, Montevideo, Uruguay
Search for more papers by this authorGabriel Rifrani
Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, Universidad de Rosario, Rosario, Argentina
Search for more papers by this authorHerman Aguirre
Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
Search for more papers by this authorNelia Hernandez
Unidad Asistencial Gastroenterología, Facultad de Medicina, Hospital de Clínicas, UdelaR, Montevideo, Uruguay
Search for more papers by this authorCarla Enrique
Unidad de Hígado y Trasplante Hepático, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorLucia Navarro
Trasplante Hepático, Hospital El Cruce, Florencio Varela, Argentina
Search for more papers by this authorEugenia Labaronnie
Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina
Search for more papers by this authorPatricia M. Zitelli
Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorAlexandre de Araujo
Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Search for more papers by this authorAntonella Olivetti
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorDaniela Simian
Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
Search for more papers by this authorDiego Giunta
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorMarcelo Silva
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Search for more papers by this authorSebastián Marciano
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorCorresponding Author
Manuel Mendizabal
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Correspondence:
Manuel Mendizabal ([email protected])
Search for more papers by this authorConstanza D. Sabate
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Search for more papers by this authorEsteban González Ballerga
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorFernando Gruz
Inmunología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorEzequiel Ridruejo
Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorAlejandro Soza
Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
Search for more papers by this authorJaime Poniachik
Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
Search for more papers by this authorGrace Vergara
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorVictoria Mainardi
Programa Nacional de Trasplante Hepático y Servicio de Hepatología, Hospital Central de Las Fuerzas Armadas, Montevideo, Uruguay
Search for more papers by this authorGabriel Mezzano
Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
Search for more papers by this authorFernando Bessone
Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, Universidad de Rosario, Rosario, Argentina
Search for more papers by this authorMargarita Anders
Unidad de Hígado y Trasplante Hepático, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorMario G. Pessoa
Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorFernando Cairo
Trasplante Hepático, Hospital El Cruce, Florencio Varela, Argentina
Search for more papers by this authorDaniela Chiodi
Unidad Asistencial Gastroenterología, Facultad de Medicina, Hospital de Clínicas, UdelaR, Montevideo, Uruguay
Search for more papers by this authorMelisa Dirchwolf
Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina
Search for more papers by this authorHugo Cheinquer
Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Search for more papers by this authorMelina Susana
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorLuis Rondeau
Programa Nacional de Trasplante Hepático y Servicio de Hepatología, Hospital Central de Las Fuerzas Armadas, Montevideo, Uruguay
Search for more papers by this authorGabriel Rifrani
Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, Universidad de Rosario, Rosario, Argentina
Search for more papers by this authorHerman Aguirre
Sección de Gastroenterología, Hospital del Salvador, Santiago, Chile
Search for more papers by this authorNelia Hernandez
Unidad Asistencial Gastroenterología, Facultad de Medicina, Hospital de Clínicas, UdelaR, Montevideo, Uruguay
Search for more papers by this authorCarla Enrique
Unidad de Hígado y Trasplante Hepático, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorLucia Navarro
Trasplante Hepático, Hospital El Cruce, Florencio Varela, Argentina
Search for more papers by this authorEugenia Labaronnie
Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina
Search for more papers by this authorPatricia M. Zitelli
Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorAlexandre de Araujo
Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Search for more papers by this authorAntonella Olivetti
Sección Hepatología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorDaniela Simian
Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
Search for more papers by this authorDiego Giunta
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorMarcelo Silva
Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
Search for more papers by this authorSebastián Marciano
Sección Hepatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Search for more papers by this authorABSTRACT
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.
Disclosure
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Conflicts of Interest Statement
The authors declare no conflicts of interest regarding this study. Outside the submitted work, the authors declare the following potential conflicts of interest: M.M. has served as a speaker for Biosidus, Gador, Gilead Sciences and Knight; and received grants/research support from AstraZeneca, Gador and Roche.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
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Data S1. |
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