{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T10:14:36Z","timestamp":1792491276285,"version":"4.5.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Treatment of hepatitis B virus (HBV) infection reduces the risk of disease progression and negative outcomes such as hepatic decompensation and hepatocellular carcinoma (HCC). Studies from select populations in the US suggest that treatment levels are low; whether this pattern occurs nationally remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify HBV treatment levels among patients who met American Association for the Study of Liver Diseases 2016 and 2018 qualification criteria in a clinical setting.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study included adult patients (aged \u226518 years at index) with an HBV diagnosis in the TriNetX Dataworks-USA Network from April 1, 2016, to December 31, 2022, with an HBV DNA laboratory result (index date), measurement of alanine aminotransferase level (2 months before to 1 month after the index date), database encounter activity (6 months or more before the index date), and no evidence of HIV, hepatitis C or D virus infection, HCC, or liver transplant. Data were analyzed from April 1, 2016, to December 31, 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n International Statistical Classification of Disease, Tenth Revision<\/jats:italic>\n , codes for HBV diagnosis, procedures, assessments, and dispensing of medication and demographic and laboratory data.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Treatment was defined by receipt of a prescription for an anti-HBV agent identified in the data with RxNorm codes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 14\u202f693 patients with HBV, 8594 met inclusion criteria, and 2134 were treated. Median age (overall, 46 [IQR, 36-57] years) was similar among treated and untreated individuals (49 [IQR, 38-61] and 45 [IQR, 35-56] years, respectively). While 4423 patients (51.5%) were female, only 538 (12.2%) qualified for treatment, compared with 904 of 4171 male patients (21.7%). Only 414 of the 724 patients (57.2%) who qualified via elevated biochemical and viral levels received treatment. Among 723 patients with advanced fibrosis (Fibrosis-4 score &amp;gt;\u20093.25) and 587 with diagnosed cirrhosis or liver decompensation, 313 (43.3%) and 235 (40.0%), respectively, were untreated. In multivariable analysis among the overall cohort, female patients were 33.0% less likely to be treated than male patients (odds ratio [OR], 0.67; 95% CI, 0.60-0.75). Compared with Asian patients, lower treatment odds were observed for African American or Black patients (OR, 0.66; 95% CI, 0.58-0.75) and White patients (OR, 0.80; 95% CI, 0.69-0.93) and those of unknown or other race (OR, 0.72; 95% CI, 0.61-0.84).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of patients with HBV infection in the US, substantial proportions of patients who met treatment criteria, including those with advanced disease, were untreated, with differences by sex and race. These findings highlight missed opportunities for prevention of negative HBV-related outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.42744","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T16:00:35Z","timestamp":1763568035000},"page":"e2542744","source":"Crossref","is-referenced-by-count":6,"title":["Hepatitis B Virus Treatment Gaps in the US"],"prefix":"10.1001","volume":"8","author":[{"given":"Robert J.","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California"},{"name":"Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Telep","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Wentworth","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunhao","family":"Liu","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarjita D.","family":"Naik","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Chiang","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anunay","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda W.","family":"Singer","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand P.","family":"Chokkalingam","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine T.","family":"Frenette","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leland J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Foster City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"issue":"10","key":"zoi251163r1","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study.","volume":"8","author":"Polaris Observatory Collaborators","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"6","key":"zoi251163r2","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1093\/cid\/ciy598","article-title":"Mortality among patients with chronic hepatitis b infection: the chronic hepatitis cohort study (CHeCS).","volume":"68","author":"Bixler","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"27","key":"zoi251163r3","doi-asserted-by":"publisher","first-page":"3643","DOI":"10.1200\/JCO.2011.36.2335","article-title":"Lifetime risk and sex difference of hepatocellular carcinoma among patients with chronic hepatitis B and C.","volume":"29","author":"Huang","year":"2011","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi251163r4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.cld.2015.01.001","article-title":"Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability.","volume":"19","author":"McGlynn","year":"2015","journal-title":"Clin Liver Dis"},{"issue":"5","key":"zoi251163r5","doi-asserted-by":"publisher","first-page":"986","DOI":"10.3390\/v14050986","article-title":"Hepatitis B virus\u2013associated hepatocellular carcinoma.","volume":"14","author":"Rizzo","year":"2022","journal-title":"Viruses"},{"issue":"7","key":"zoi251163r6","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.14309\/ajg.0000000000001195","article-title":"Antiviral therapy reduces risk of cirrhosis in noncirrhotic HBV patients among 4 urban safety-net health systems.","volume":"116","author":"Wong","year":"2021","journal-title":"Am J Gastroenterol"},{"issue":"15","key":"zoi251163r7","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1056\/NEJMoa033364","article-title":"Lamivudine for patients with chronic hepatitis B and advanced liver disease.","volume":"351","author":"Liaw","year":"2004","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi251163r8","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.cgh.2013.09.062","article-title":"Antiviral therapy for chronic hepatitis B virus infection and development of hepatocellular carcinoma in a US population.","volume":"12","author":"Gordon","year":"2014","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"zoi251163r9","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1111\/apt.14497","article-title":"Review article: long-term safety of oral anti-viral treatment for chronic hepatitis B.","volume":"47","author":"Wong","year":"2018","journal-title":"Aliment Pharmacol Ther"},{"issue":"4","key":"zoi251163r10","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/apt.13895","article-title":"Effects of nucleoside analogue prescription for hepatitis B on the incidence of liver cancer in Hong Kong: a territory-wide ecological study.","volume":"45","author":"Seto","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"issue":"2","key":"zoi251163r11","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.jhep.2017.03.021","article-title":"EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.","volume":"67","author":"European Association for the Study of the Liver","year":"2017","journal-title":"J Hepatol"},{"issue":"1","key":"zoi251163r12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12072-015-9675-4","article-title":"Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update.","volume":"10","author":"Sarin","year":"2016","journal-title":"Hepatol Int"},{"issue":"4","key":"zoi251163r14","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.","volume":"67","author":"Terrault","year":"2018","journal-title":"Hepatology"},{"issue":"5","key":"zoi251163r15","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1093\/cid\/ciad617","article-title":"Disparities in antiviral treatment among adults with hepatitis B cirrhosis: an analysis of the National Veterans Affairs Cohort.","volume":"78","author":"Wong","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"9","key":"zoi251163r16","doi-asserted-by":"publisher","first-page":"1909","DOI":"10.1016\/j.cgh.2018.10.003","article-title":"Low rates of linkage and retention into care among patients with chronic HBV Infection.","volume":"17","author":"Tang","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"4","key":"zoi251163r17","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1097\/MCG.0000000000001530","article-title":"Low rates of hepatitis B virus treatment among treatment-eligible patients in safety-net health systems.","volume":"56","author":"Wong","year":"2022","journal-title":"J Clin Gastroenterol"},{"issue":"10","key":"zoi251163r18","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae571","article-title":"Sociodemographic disparities in hepatitis B treatment: a real-world analysis of 3 safety-net health systems in the United States.","volume":"11","author":"Wong","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"4","key":"zoi251163r19","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.7018","article-title":"Racial disparities in treatment initiation and outcomes of chronic hepatitis B virus infection in North America.","volume":"6","author":"Khalili","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"29","key":"zoi251163r20","doi-asserted-by":"publisher","first-page":"648","DOI":"10.15585\/mmwr.mm7329a3","article-title":"Progress toward elimination of mother-to-child transmission of hepatitis B virus\u2014region of the Americas, 2012\u20132022.","volume":"73","author":"Alleman","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"3","key":"zoi251163r21","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1093\/cid\/ciz841","article-title":"Trends in hepatitis B infection and immunity among women of childbearing age in the United States.","volume":"71","author":"Kushner","year":"2020","journal-title":"Clin Infect Dis"},{"key":"zoi251163r22","doi-asserted-by":"publisher","DOI":"10.1200\/CCI.17.00067","article-title":"Using a federated network of real-world data to optimize clinical trials operations.","author":"Topaloglu","year":"2018","journal-title":"JCO Clin Cancer Inform"},{"issue":"6","key":"zoi251163r23","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection.","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"issue":"1","key":"zoi251163r24","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1002\/hep.28156","article-title":"AASLD guidelines for treatment of chronic hepatitis B.","volume":"63","author":"Terrault","year":"2016","journal-title":"Hepatology"},{"issue":"1","key":"zoi251163r26","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.jhep.2024.02.033","article-title":"Sex and ethnic disparities in hepatitis B evaluation and treatment across the world.","volume":"81","author":"Kudaravalli","year":"2024","journal-title":"J Hepatol"},{"issue":"6","key":"zoi251163r28","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.14218\/JCTH.2023.00320","article-title":"Guidelines for the prevention and treatment of chronic hepatitis B (version 2022).","volume":"11","author":"You","year":"2023","journal-title":"J Clin Transl Hepatol"},{"issue":"2","key":"zoi251163r29","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.jhep.2025.03.018","article-title":"EASL clinical practice guidelines on the management of hepatitis B virus infection.","volume":"83","author":"Cornberg","year":"2025","journal-title":"J Hepatol"},{"issue":"1","key":"zoi251163r30","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1001\/jama.295.1.65","article-title":"Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level.","volume":"295","author":"Chen","year":"2006","journal-title":"JAMA"},{"issue":"1","key":"zoi251163r31","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1186\/s12913-022-07813-w","article-title":"Exploring factors associated with hepatitis B screening in a multilingual and diverse population.","volume":"22","author":"Chu","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"zoi251163r32","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035","article-title":"A global federated real-world data and analytics platform for research.","volume":"6","author":"Palchuk","year":"2023","journal-title":"JAMIA Open"},{"issue":"2","key":"zoi251163r33","doi-asserted-by":"publisher","first-page":"24","DOI":"10.71079\/ASIDE.IM.03222516","article-title":"TriNetX and real-world evidence: a critical review of its strengths, limitations, and bias considerations in clinical research.","volume":"1","author":"Nassar","year":"2025","journal-title":"ASIDE Intern Med"},{"key":"zoi251163r13","unstructured":"Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. World Health Organization. March 29, 2024. Accessed August 11, 2025. https:\/\/www.Who.Int\/publications\/i\/item\/9789240090903"},{"key":"zoi251163r25","unstructured":"Unified Medical Language System: RxNorm overview. National Library of Medicine. Updated January 7, 2025. Accessed August 11, 2025. https:\/\/www.nlm.nih.gov\/research\/umls\/rxnorm\/overview.html"},{"key":"zoi251163r27","unstructured":"CDC\u2019s division of reproductive health works to improve mental health among women of reproductive age. Centers for Disease Control and Prevention. 2014. Accessed August 11, 2025. https:\/\/www.cdc.gov\/ccindex\/pdf\/MentalHealthAmongWomenofReproductiveAge_vB.pdf"},{"key":"zoi251163r34","unstructured":"Table 2.1\u2014acute hepatitis B: numbers & rates of cases. Centers for Disease Control and Prevention. August 7, 2023. Accessed August 11, 2025. https:\/\/www.cdc.gov\/hepatitis-surveillance-2021\/hepatitis-b\/table-2-1.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2841640\/wong_2025_oi_251163_1762977914.82881.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T16:00:36Z","timestamp":1763568036000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2841640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":34,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.42744","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]}}}