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Intern Med J. 2019 Aug 26. doi: 10.1111/imj.14622. [Epub ahead of print]

Clinical factors leading to a change in management in chronic hepatitis B patients managed in a tertiary setting.

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School of Medicine, The University of Adelaide, Adelaide, South Australia, 5000, Australia.
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.



Newer antiviral agents for CHB are highly effective, with minimal risks of complications and development of resistance. We hope to identify the proportion of patients with CHB on treatment who will not require alteration of management, and clinical factors of those who will require closer monitoring.


Patients with CHB who were on either entecavir and/or tenofovir between January 2011 and December 2016 were retrospectively studied. According to the initial treatment plan provided by the managing physician, any deviation in the interval of follow-up, choice of investigations and alteration of medical therapy were considered as a change in CHB management. We additionally evaluated the predictability of these changes, factors associated with higher frequency of change and the additional cost of managing stable patients with CHB in a tertiary setting.


75.7% (n = 87/115) did not have a change in CHB management. 85.6% of the changes in management were predictable based on liver function tests, HBV DNA PCR levels and liver ultrasound. Interpreter use (OR (95% CI) = 2.41 (1.01-5.76)), liver cirrhosis (OR (95% CI) = 4.11 (1.44-11.75)) and immunosuppression (OR (95% CI) = 3.81 (1.2-12.06)) were associated risk factors. Overall, there was an incremental annual cost of AUD $60 166 to manage patients who did not require alteration of their CHB management in our institution.


The majority of stable CHB patients on highly potent antiviral treatment do not require alteration of management. Whilst additional investigations are required, this study highlights the potential for a shared primary care approach in highly selected CHB patients. This article is protected by copyright. All rights reserved.


Hepatology; cirrhosis; compliance/ adherence; health economics; hepatitis B; viral hepatitis


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