Linkage to care and treatment in the United States

“In a 2008–2016 study of adults with chronic HBV infection and commercial insurance, 36% (6,004 of 16,644) of patients were linked to care (defined as having had an ALT test and HBV DNA or HBeAg test) (51). Of the patients with chronic HBV infection with prescription claims, 18% (2,926 of 16,572) were treated.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote
“Persons who receive a diagnosis of chronic HBV infection can benefit from monitoring and counseling, including mental health support (111).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“About half of the cohort (n = 6,559, 52.3%) did not have a complete laboratory evaluation (defined as having HBeAg, HBV DNA, and ALT tests) and only 72.4% (n = 9,129) had an "adequate" evaluation (at least HBV DNA and ALT) during the entire study period. Of those with an adequate evaluation, 11.2% were treatment eligible by AASLD criteria and 13.9% by EASL criteria; 60.4% of AASLD eligible patients and 54.3% of EASL eligible patients received treatment within 12 months from becoming eligible.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote
“Patients who visited a specialist had a higher chance of receiving adequate evaluation and treatment.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Global cascade of care

“Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Disparities in evaluation and treatment initiation

“Overall, 73.3% (9,206 patients) received adequate evaluation. Among the adequately evaluated, 32.6% (3,001 patients) were treatment eligible by AASLD criteria, 83.3% (2,500 patients) of whom were initiated on NAs, with consistent findings in analyses using EASL criteria.” (opens the source at this quote in a new tab)
“Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.” (opens the source at this quote in a new tab)

Specialist care and referral

“People with chronic hepatitis B should be under the care of a clinician with expertise in managing hepatitis B.” (opens the source at this quote in a new tab)

Hepatocellular carcinoma surveillance recommendations: AASLD/IDSA 2025 guideline

“In persons who achieved HBsAg loss, AASLD suggests continued HCC surveillance for those with cirrhosis, with family history of HCC, men who experienced HBsAg loss after age 40, and women who experienced HBsAg loss after age 50 years.” (opens the source at this quote in a new tab)
“HCC surveillance with ultrasound and serum AFP performed at semiannual (approximately every 6 mo) intervals is recommended as the most cost-effective approach per the 2023 AASLD HCC guideline.” (opens the source at this quote in a new tab)
“CHB infection is the most common cause of HCC worldwide.” (opens the source at this quote in a new tab)

Hepatocellular carcinoma surveillance recommendations: EASL 2025 guideline

“HCC surveillance should involve abdominal ultrasound performed every 6 months by an experienced operator in all at-risk populations (LoE 2, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)
“HCC surveillance should be continued in at-risk patients irrespective of effective antiviral therapy or HBsAg loss (LoE 2, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)

Use of hepatocellular carcinoma surveillance in practice: U.S. claims data

“Of 6831 patients (1122 on antiviral treatment, 5709 untreated), only 39.3% and 51.3% had received any abdominal imaging after 6 and 12 months, respectively, and patients were up to date with HCC surveillance guidelines for only 28% of the follow‐up time.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Monitoring during nucleos(t)ide analogue therapy

“HBsAg status should be tested every 12 months. Ideally, a quantitative determination of HBsAg should be performed (LoE 3, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)
“In the event of a partial virological response or virological non-response (Box 1), the patient's adherence to treatment should be assessed in the first instance (LoE 1, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)

Monitoring after nucleos(t)ide analogue cessation following bepirovirsen

“Severe acute exacerbations of HBV infection may occur after discontinuation of anti-HBV therapy. If NrtI therapy is discontinued after completing HIBSAGO treatment, frequent monitoring is recommended. Patients should be closely monitored with both laboratory (HBsAg, HBV DNA, and hepatic function) and clinical follow-up for at least one year following NrtI therapy cessation, with routine monitoring as clinically indicated afterwards, to detect acute exacerbations of HBV infection and the possible need for resumption of HBV treatment.” (opens the prescribing information at this quote)

“In studies of treatment withdrawal, HBV DNA and ALT levels should be frequently monitored during the first 6-12 months.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Screening and vaccination of contacts

“All patients who test positive for active HBV infection should be provided information on how to prevent transmission to others (Box 5). Notification, testing, and vaccination of their household contacts or former household contacts, sex partners, and needle-sharing contacts are recommended, as appropriate.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote
“In a study of programs testing and linking patients with hepatitis B to care in the United States, 14% of household contacts of persons who were HBsAg positive were themselves HBsAg positive, and 30% had a history of infection (anti-HBc positive) (55).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“HBV vaccination is the primary intervention to prevent HBV transmission to susceptible individuals in all settings, including those with a known higher risk of exposure.” (opens the source at this quote in a new tab)

“Taking HIBSAGO does not stop you from passing HBV to others.” (opens the prescribing information at this quote)