Clinician adherence to screening protocols for patients with hepatitis B (HBV), as well as to treatment guidelines for patients with hepatitis C virus (HCV) is suboptimal, according to research results presented at the American Association for the Study of Liver Diseases’ The Liver Meeting, held November 8 to 12, 2019 in Boston, Massachusetts.
According to Moore and colleagues1, adherence to guidelines for hepatitis D (HDV) screening in high-risk individuals was poor. Although there is limited access to data on testing and reporting, previous research has shown that approximately 5% to 42% of patients with HBV may also have HDV.
This comorbid infection is considered the most aggressive form of viral hepatitis and is associated with cirrhosis, hepatocellular carcinoma, and liver failure. For these reasons, both the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver recommend screening for HDV and other chronic liver diseases in all individuals with HBV. Of 339 patients with HBV, 90 (27%) were screened for HDV; among other high-risk patients, 1 of 9 patients with HIV (11%) and 1 of 13 patients with HCV (8%) were screened.1
In another study Schwartz et al used an online decision support tool to determine whether treatment plans for patients with comorbid HCV/HIV aligned with the guidelines developed by the American Association for the Study of Liver Diseases/Infectious Diseases Society of America and the Department of Health and Human Services. The tool was developed to use the following simplified set of patient variables to produce individualized guideline-based recommendations: current HIV/HCV therapy, HIV and HCV genotypes, liver histology, renal function, and HLA-B*5701 status.
Between August 2018 and March 2019, clinicians entered 694 patient cases into the tool. Proposed treatment that was divergent from recommendation or uncertainty in treatment occurred in 36% (248) of the scenarios. Among clinicians who identified their divergence (n=47) and chose to provide feedback, 40% reported barriers to implementation of the guidelines; 23% expressed continued uncertainty as to whether to follow the guidelines; and 4% disagreed with the guidance.2
Both of these studies demonstrate the need for significant improvements in concordance of clinical practices with guideline recommendations. This need is significantly highlighted by the fact that lack of awareness of guidelines or trust in automated processes for providing recommendations results in fewer patients screening in a timely and appropriate manner.
1. Moore A, Mitchell J, Reau N. Clinicians fail to screen for HDV in patients with HBV despite guideline recommendations. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 957.
2. Schwartz Z, Schulz J, King E, Naggie S, Sulkowski M. Variance between clinicians and guidelines in management of HIV/HCV coninfection. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 1579.