Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America
Authors: Khalili Mandana , Leonard Kelsey R. , Ghany Marc G. , Hassan Mohamed , Roberts Lewis R. , Sterling Richard K. , Belle Steven H. , Lok Anna S. ,   Hepatitis B Research Network, Lau Daryl T-Y , Chung Raymond T. , Di Bisceglie Adrian M , Lisker-Melman Mauricio , Janssen Harry L. A. , Wong David K. , Juan Joshua , Feld Jordan , Yim Colina , Lee William M. , Murakam Carol S. , Perrillo Robert , Do Son , Han Steven-Huy B. , Tran Tram T. , Terrault Norah A. , Cooper Stewart L. , Fontana Robert J. , Tsai Naoky , Younoszai Barak , Fried Michael W. , Darling Jama M. , Muir Andrew , Evon Donna , Carithers Robert C. , Shuhart Margaret , Kowdley Kris V. , Wang Chia C. , Luketic Velimir A. , Liang T. Jake , Hoofnagle, Jay H. , Doo Edward , Chang Kyong-Mi , Park Jang-June , Wahed Abdus , King Wendy C. , Kleiner David 
Published: April 2023

Importance

Disparities in treatment initiation may affect outcomes, but data on racially diverse populations with chronic hepatitis B virus (HBV) infection are limited.

Objective

To examine whether HBV treatment initiation and outcomes differ among racial groups.

Design, Setting, and Participants

From January 14, 2011, to January 28, 2018, hepatitis B surface antigen—positive adults (age ≥18 years) not receiving anti-HBV therapy were enrolled and followed up at weeks 12, 24, and every 24 weeks thereafter in a multicenter longitudinal cohort study (Hepatitis B Research Network [HBRN] adult cohort study) conducted in North America. The last study visit and data collection were completed January 28, 2019. Data were analyzed from August 27, 2021, to August 25, 2022. All HBRN participants were included unless they had acute HBV, HIV, hepatitis C or D, less than 24-weeks of follow-up after enrollment, initiated treatment at or immediately after enrollment, or had unknown race.

Exposures

Participants had clinical and laboratory assessments and could receive anti-HBV treatment after enrollment.

Main Outcomes and Measures

Hepatitis B virus treatment initiation and major adverse liver outcomes (hepatic decompensation, hepatocellular carcinoma, liver transplant, and death).

Results

Of 1550 participants, 193 (12%) were African American or Black, 1157 (75%) were Asian, 157 (10%) were White, and 43 (3%) were other races; 789 (51%) were women, and the median age was 41.2 (IQR, 32.9-51.6) years. Sociodemographic and virologic parameters differed between groups. During 5727 person-years of follow-up, 504 participants initiated treatment, with incidences of 4.8 per 100 person-years in African American or Black individuals, 9.9 per 100 person-years in Asian individuals, 6.6 per 100 person-years in White individuals, and 7.9 per 100 person-years in those of other races (P &amp;lt; .001). A lower proportion (14%) of African American or Black participants met treatment criteria compared with Asian (22%) and White (27%) individuals (P = .01). The cumulative probabilities of treatment initiation after meeting the criteria were not significantly different among racial groups (African American or Black, 0.45; Asian, 0.38; White, 0.40 at 48 weeks and African American or Black, 0.45; Asian, 0.51; White, 0.51 at 72 weeks; P = .68). The incidence of major adverse liver outcomes was 0.1 per 100 person-years and did not differ by race.

Conclusions and Relevance

In this observational study of chronic HBV, African American or Black participants were less likely than individuals of other races to meet treatment criteria, but among those who did, HBV treatment receipt did not differ significantly by race or socioeconomic factors. Not all eligible participants initiated treatment, but adverse liver outcomes were rare. These findings may not be generalizable to patients with chronic HBV receiving care in other settings.