Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Clin Infect Dis. 2022 Oct 29;75(9):1529-1536. doi: 10.1093/cid/ciac227.
Guideline-adherent hepatitis B virus (HBV) care is critical for patients with HBV, particularly patients with HBV-human immunodeficiency virus (HIV) given increased risks of liver-related complications. However, a comprehensive assessment of HBV-related care in patients with HBV-HIV is lacking.
We retrospectively assessed adherence to HBV-related care guidelines in all patients with HBV-HIV and HBV monoinfection (HBV-M) in the national Veterans Health Administration healthcare system in 2019.
We identified 1021 patients with HBV-HIV among 8323 veterans with chronic HBV. Adherence to HBV guidelines was similar or better in HBV-HIV versus HBV-M, including HBV treatment (97% vs 71%), biannual hepatocellular carcinoma (HCC) surveillance (55% vs 55%) for patients with cirrhosis, hepatitis A virus screening (69% vs 56%), hepatitis C virus screening (100% vs 99%), and on-therapy alanine aminotransferase monitoring (95% vs 96%). Compared with those seeing gastroenterology (GI) or infectious diseases (ID) providers, patients without specialty care were less likely to receive antiviral treatment (none, 39%; GI, 80%; ID, 84%) or HCC surveillance (none, 16%; GI, 66%; ID, 47%). These findings persisted in multivariable analysis. Compared with ID care alone, a higher proportion of patients with HBV-HIV seen dually by GI and ID received HCC surveillance (GI + ID 73% vs ID 31%) and on-therapy HBV-DNA monitoring (GI + ID, 82%; ID, 68%).
Patients with HBV-HIV received similar or higher rates of guideline-adherent HBV-related care than patients with HBV-M. Patients with HBV-HIV under dual GI and ID care achieved higher quality care compared with ID care alone. Specialty care was independently associated with higher quality HBV care in patients with HBV-HIV and HBV-M.
乙型肝炎病毒 (HBV) 治疗指南的遵循对 HBV 患者至关重要，尤其是乙型肝炎病毒-人类免疫缺陷病毒 (HBV-HIV) 合并感染患者，因为他们有更高的肝脏相关并发症风险。然而，目前缺乏对 HBV-HIV 患者的 HBV 相关护理的综合评估。
我们回顾性评估了 2019 年国家退伍军人健康管理局医疗保健系统中所有 HBV-HIV 和 HBV 单感染 (HBV-M) 患者的 HBV 相关护理指南的遵循情况。
我们在 8323 例慢性 HBV 退伍军人中发现了 1021 例 HBV-HIV 患者。HBV-HIV 患者的 HBV 指南遵循情况与 HBV-M 患者相似或更好，包括 HBV 治疗（97%对 71%）、肝硬化患者每半年进行一次肝细胞癌 (HCC) 监测（55%对 55%）、甲型肝炎病毒筛查（69%对 56%）、丙型肝炎病毒筛查（100%对 99%）和治疗期间丙氨酸氨基转移酶监测（95%对 96%）。与接受胃肠病学 (GI) 或传染病 (ID) 医生治疗的患者相比，没有专科治疗的患者接受抗病毒治疗的可能性较小（无治疗，39%；GI，80%；ID，84%）或 HCC 监测（无治疗，16%；GI，66%；ID，47%）。这些发现在多变量分析中仍然存在。与单独接受 ID 护理相比，同时接受 GI 和 ID 双重护理的 HBV-HIV 患者接受 HCC 监测（GI+ID，73%；ID，31%）和治疗期间 HBV-DNA 监测（GI+ID，82%；ID，68%）的比例更高。
HBV-HIV 患者接受的指南一致的 HBV 相关护理与 HBV-M 患者相似或更高。同时接受 GI 和 ID 双重护理的 HBV-HIV 患者与单独接受 ID 护理的患者相比，获得了更高质量的 HBV 护理。专科护理与 HBV-HIV 和 HBV-M 患者的高质量 HBV 护理独立相关。
