For Racial Disparities in Chronic Hepatitis B Treatment, Look at the Treatment Criteria

Like many diseases, chronic hepatitis B is rife with racial disparities. In the U.S., there are a disproportionate number of people of Asian and African descent among the 2.4 million people with chronic hepatitis B. Moreover, \white persons with chronic hepatitis B are less likely to develop hepatocellular carcinoma, the main form of liver cancer, than Asian American or African American persons with the infection. There are other notable differences that follow racial lines.

Now researchers are attempting to tease out the specific factors responsible for the disparities, possibly producing findings that would help public health officials, professional societies and others zero in on the changes that would close the gaps.

Results of a study published in April in the JAMA Network Open both adds to the understanding of chronic hepatitis B disparities while layering in further complexity to the full picture.

Mandana Khalili, M.D.

A research team led by Mandana Khalili, M.D., of the University of California found that African and Black individuals were less likely to start treatment than Asian or White individuals. But they also found that a lower percentage (14%) of African America or Black individuals met the criteria for starting treatment than Asian (22%) and White (27%) individuals. Once people met the treatment criteria, the rates of treatment did not differ by race nor did differences in education, household income and type of health insurance make a difference matter.

The researchers’ chief takeaway: racial disparity in rates of treatment initiation were not identified among those meeting the treatment criteria.

Of course, that leads to questions about whether there are biases in the treatment criteria, which various professional societies have established.

Key aspects of the chronic hepatitis B treatment criteria involve the presence of cirrhosis, levels of hepatitis B antigen and of the DNA of the virus. Khalili and her coauthors note that African or Black participants in this study had a lower prevalence of hepatitis B antigen and lower levels of hepatitis B DNA.

“An important concern raised by some experts is whether thresholds for starting therapy should be lower in African Americans or Black individuals compared with those of other races,” they wrote in the discussion part of the paper. They left it an open issue and did not take a stand on whether the criteria should be changed.

Khalili and her colleagues leveraged longitudinal data from the Hepatitis B Research Network (HBRN) adult cohort study from January 2014 to January 2018 to conduct this study.

The 1,550 participants in the study were HBV positive and not receiving anti-HBV therapy. The group came from 20 US centers and one center in Toronto, Canada. The participants included 193 (12%) African American or Black, 157 (75%) Asian, 157 (10%) White, and 43 (3%) of other races. Race and household income were self-reported. The median age of the participants was 41.2 years old and 51% (789) were women.

During the years the study covered, 504 participants (35 African American or Black, 415 Asian, 42 White and 12 other races) initiated antiviral treatment.