OP-3 ASSESSING TREATMENT ELIGIBILITY EXPANSION UNDER THE 2024 WHO GUIDELINES FOR CHRONIC HEPATITIS B

Conflict of interest

No

Introduction and Objectives

The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility, but these criteria have not been assessed. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate potential treatment expansion based on the WHO guidelines.

Patients / Materials and Methods

This cross-sectional study included consecutive treatment-naïve CHB patients from Argentina, Brazil, Chile, and Uruguay who were referred for the first time to hepatology evaluation between January 2010 and June 2024. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. We then estimated the difference in treatment candidacy between these two approaches.

Results and Discussion

A total of 719 patients with CHB had complete data available to evaluate treatment candidacy according to both guidelines. Of these patients, 67% were male with a median age of 52 years (IQR 38-62), and 8.1% presented with liver decompensation. Among patients, 64% were HBeAg-negative, median HBV DNA level was 43,000 IU/ml (IQR 633-110,000,000 IU/ml), median ALT was 41 U/L (IQR 23-99 U/L), and 47% had an APRI >0.5. According to country-specific guidelines, 57% (95% CI: 53-60) met criteria for treatment. Antiviral treatment was initiated in 84% of eligible patients, primarily with entecavir (63%) and tenofovir (32%). Compared to country-specific guidelines, the proportion of patients meeting treatment criteria under the WHO guidelines increased to 67% (95% CI: 63.8-70.6), resulting in a 10% (95% CI: 8-13) increase in treatment candidacy (table). Treatment expansion was higher in women (15%; 95% CI: 10-20) than in men (8%; 95% CI: 5-11).

Conclusions

According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Notably, treatment expansion is higher in women. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.

The absolute number and percentage of individuals for whom the criteria according to the local guidelines were concordant or discordant with the WHO treatment criteria are presented (n=719)