Oral Antiviral Therapy Uptake Low for HBV-Related Hepatocellular Carcinoma

Low rates of oral antiviral therapy use were observed among patients with HBV-related HCC, suggesting the need for interventions to increase treatment uptake among this population.

Results of a study published in Clinical Gastroenterology and Hepatology indicate that only one-third of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) use oral antiviral therapy despite adequate health insurance coverage.

The aim of this study was to assess rates of oral antiviral therapy use and survival outcomes among patients with HBV-related HCC. Researchers at Stanford University in the United States sourced data for this study from the Optum® de-identified Clinformatics™ Data Mart. The study population comprised patients who were diagnosed with HBV-related HCC between 2003 and 2021. The primary outcome was oral antiviral therapy use, with treatment rate defined as the percentage of patients who received at least 1 prescription for HBV medication in the overall population.

Among 2129 patients included in the analysis, the mean (SD) age was 62.7 (12.5) years, 70.7% were men, 40.4% were Asian, 31% were White, 45.0% had decompensated cirrhosis, 13.6% were liver transplant recipients, and the mean (SD) Charlson comorbidity index (CCI) score was 7.81 (4.42).

Overall, 783 (36.8%) patients received oral antiviral therapy, of whom 39.2% received entecavir, 31.8% received tenofovir disoproxil fumarate, and 7.3% received tenofovir alafenamide. The remaining treatment recipients received combinatorial or sequential therapies.

These data serve as a call to action to improve awareness and streamline access to care for all patients with HBV-related HCC…

Significant predictors of oral antiviral therapy receipt were assessed via multivariable logistic regression, with adjustments for age, sex, race/ethnicity, care provider type, cirrhosis, and time period. In regard to race/ethnicity, Asian patients were the most likely to receive therapy (adjusted odds ratio [aOR], 3.57; P <.001), followed by Black vs White patients (aOR, 1.81; 95% CI, 1.26-2.60; P =.0013). Other predictors were as follows:

  • Male vs female sex (aOR, 1.59; 95% CI, 1.28-1.97; P <.001);
  • Index HCC after vs before 2010 (aOR, 2.32; 95% CI, 1.83-2.95; P <.001);
  • Compensated cirrhosis vs no cirrhosis (aOR, 2.20; 95% CI, 1.71-2.84; P <.001); and
  • Prior specialist visit vs no visit (aOR, 1.48; 95% CI, 1.10-1.99; P =.0091).

Survival differed significantly over time by oral antiviral therapy receipt (P <.0001), with higher survival rates at 5 years observed among recipients vs nonrecipients (61.3% vs 48.6%). Oral antiviral recipients had higher survival rates for all sex-, race/ethnicity-, and cirrhosis-based subgroups.

Improved survival was associated with prior liver transplantation (adjusted hazard ratio [aHR], 0.22; 95% CI, 0.17-0.29; P <.0001) and oral antiviral therapy receipt (aHR, 0.84; 95% CI, 0.72-0.99; P =.037).

Significant independent predictors of worse survival outcomes were as follows:

  • Decompensated cirrhosis vs no cirrhosis (aHR, 2.51; 95% CI, 1.99-3.18; P <.001);
  • Black vs White race/ethnicity (aHR, 1.31; 95% CI, 1.03-1.65; P =.026);
  • Male sex (aHR, 1.27; 95% CI, 1.09-1.49; P =.0027);
  • Higher CCI scores (aHR, 1.08; 95% CI, 1.06-1.10; P <.001); and
  • Older age (aHR, 1.01; 95% CI, 1.06-1.10; P <.001).

This study was limited by insufficient patient data, including data needed to determine cause of death and treatment adherence.

According to the researchers, “These data serve as a call to action to improve awareness and streamline access to care for all patients with HBV-related HCC…”


Kudaravalli S, Kam LY, Huang DQ, Cheung R, Nguyen MH. Utilization of antiviral therapy for patients with hepatitis B-related hepatocellular carcinoma: a nationwide real-world US study. Clin Gastroenterol Hepatol. Published online April 29, 2023. doi:10.1016/j.cgh.2023.04.020