Factors Associated With Underutilization of Antiviral Therapy in Preventing Hepatitis B Virus-Related Hepatocellular Carcinoma.

BACKGROUND

Deaths from hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) are projected to increase through 2030. Underutilisation of antiviral therapy may contribute to this concerning trend but empirical data remain sparse.

AIMS: We aimed to assess the frequency of missed opportunities for antiviral therapy before HBV-related HCC development and to investigate factors associated with non-treatment.

METHODS

We analysed the electronic medical records from a large healthcare group in Taiwan to identify all HBV-infected patients who developed HCC between 1 April 2004 and 24 May 2022. HBV infection was confirmed by hepatitis B surface antigen seropositivity and incident HCC was verified through the cancer registry. Patients were grouped based on whether they had received antiviral therapy prior to the HCC diagnosis.

RESULTS

Among 1017 patients with HBV-related HCC (median age, 60.8 years; 80.1% male; 42.9% with cirrhosis), 75% had not received antiviral therapy before developing HCC. Compared to treated patients, the untreated group had a significantly lower proportion of cirrhosis (33.5% vs. 71.0%), higher platelet counts, elevated liver enzyme levels, and higher viral loads. They also had significantly fewer specialist visits (median frequency, 0.3 vs. 3.6 visits per year) and biomarker evaluations, and were less frequently diagnosed at early stages (Stage I/II, 49.5% vs. 81.6%) with a significantly shorter median survival (2.1 vs. 4.4 years).

CONCLUSION

Three-quarters of patients who developed HBV-related HCC had not received antiviral therapy before HCC diagnosis. These patients were characterised by a lower proportion of cirrhosis, infrequent clinical visits, fewer HBV evaluations, more advanced HCC stage, and poorer prognosis.