Patrik Garren1, Marina Serper1,2,3. 1. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine. 2. Corporal Michael J. Crescenz VA Medical Center. 3. Leonard Davis Institute of Health Economics.
Abstract
PURPOSE OF REVIEW: This review summarizes recent data on chronic Hepatitis B virus (HBV) epidemiology, issues in special populations undergoing immunosuppressive and hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy, and describes care delivery, adherence to guideline-recommended care, and barriers to access to care and high-quality care for chronic HBV. RECENT FINDINGS: Chronic HBV is present in up to 1% of veterans and is more than in the general US population. HBV associated with more advanced liver disease in HCV, HIV, and delta hepatitis co-infection. Recent data on HBV reactivation show a substantial risk of reactivation with anti-CD20 antibodies, no documented cases of reactivation with anti-tumor necrosis factor (anti-TNF) therapy, and a low risk of reactivation with HCV DAA therapy. Adherence to guideline-recommended care for HBV is suboptimal for many quality indicators. SUMMARY: Important studies in HBV epidemiology, long-term outcomes and care delivery practices have been conducted in the VA. Future studies should prospectively investigate how to improve guideline-recommended care for HBV.
PURPOSE OF REVIEW: This review summarizes recent data on chronic Hepatitis B virus (HBV) epidemiology, issues in special populations undergoing immunosuppressive and hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy, and describes care delivery, adherence to guideline-recommended care, and barriers to access to care and high-quality care for chronic HBV. RECENT FINDINGS: Chronic HBV is present in up to 1% of veterans and is more than in the general US population. HBV associated with more advanced liver disease in HCV, HIV, and delta hepatitis co-infection. Recent data on HBV reactivation show a substantial risk of reactivation with anti-CD20 antibodies, no documented cases of reactivation with anti-tumor necrosis factor (anti-TNF) therapy, and a low risk of reactivation with HCV DAA therapy. Adherence to guideline-recommended care for HBV is suboptimal for many quality indicators. SUMMARY: Important studies in HBV epidemiology, long-term outcomes and care delivery practices have been conducted in the VA. Future studies should prospectively investigate how to improve guideline-recommended care for HBV.
Entities:
Keywords:
Care Quality; Cirrhosis; Hepatitis B Epidemiology; Hepatitis B reactivation; Hepatitis Delta; Hepatocellular Carcinoma
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