Clinical burden, disease progression, and management strategies in chronic hepatitis B: implications for public health practice.

BACKGROUND

Chronic hepatitis B (CHB) is one of the most significant global public health issues because it is progressive and has long-term complications, with gaps in real-world management. Longitudinal cohort evidence is required to guide effective disease control strategies.

OBJECTIVE

This study aimed to evaluate the clinical burden, disease progression, and management strategies in patients with CHB and to identify factors influencing progression and treatment outcomes in a real-world setting.

METHODS

The study design was a retrospective longitudinal cohort study conducted at a tertiary-care academic referral centre between January 2020 and December 2025. A total of 520 patients were analysed, all of whom were confirmed to have CHB and followed longitudinally through routine clinical care for a mean duration of 4.1 years. Assessment was made on clinical burden, disease progression and management strategies. Kaplan-Meier analyses were used to determine progression-free survival, and multivariable Cox proportional hazards regression was used to determine independent predictors of disease progression.

FINDINGS: 21.5% of patients in the baseline group were found to have significant fibrosis, and 9.8% of the patients had cirrhosis. Follow-up discovered disease evolution in 22.3%, including cirrhosis (11.9%), hepatocellular carcinoma (6.9%), and liver death (5.4%). 46.2% of the patients received antiviral therapy, which was associated with a high rate of progression-free survival. Older age, high levels of HBV DNA, baseline fibrosis, ALT elevation and diabetes mellitus were all independent predictors of disease progression, and antiviral therapy had a very strong protective effect (adjusted HR 0.52, 95% CI 0.36-0.75). It is important to note that almost 20% of eligible patients were not treated, and unstable monitoring was associated with poor clinical outcomes.

CONCLUSION

CHB is associated with a significant clinical and healthcare burden. Antiviral interventions and regular observation in the early stages of the disease can greatly slow disease progression, and it is therefore crucial to enhance population health interventions to ensure a smooth transition between the guidelines applied and actual practice.