{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:23:20Z","timestamp":1785813800679,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: International guidelines for hepatitis B infection (HBV) recommend initiating antiviral treatment based on viral replication with inflammation or fibrosis. HBV viral loads and liver fibrosis measurements are not widely available in resource-limited countries. Aim: To develop a novel scoring system for the initiation of antiviral treatment in HBV-infected patients. Methods: We examined 602 and 420 treatment-na\u00efve, HBV mono-infected patients for derivation and validation cohorts. We performed regression analysis to identify parameters associated with the initiation of antiviral treatment based on the European Association for the Study of the Liver (EASL) guidelines. The novel score was developed based on these parameters. Results: The novel score (HePAA) was based on HBeAg (hepatitis B e-antigen), the platelet count, alanine transaminase, and albumin. The HePAA score showed excellent performance, with AUROC values of 0.926 (95% CI, 0.901\u20130.950) for the derivation cohort and 0.872 (95% CI, 0.833\u20130.910) for the validation cohort. The optimal cutoff was \u22653 points (sensitivity, 84.9%; specificity, 92.6%). The HePAA score performed better than the World Health Organization (WHO) criteria and the Risk Estimation for HCC in Chronic Hepatitis B (REACH-B) score, and it performed similarly to the Treatment Eligibility in Africa for HBV (TREAT-B) score. Conclusions: The HePAA scoring system is simple and accurate for chronic hepatitis B treatment eligibility in resource-limited countries.<\/jats:p>","DOI":"10.3390\/v15030724","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T06:09:56Z","timestamp":1678687796000},"page":"724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8346-7487","authenticated-orcid":false,"given":"Tanawat","family":"Geeratragool","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2926-8671","authenticated-orcid":false,"given":"Pisit","family":"Tangkijvanich","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand"},{"name":"Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supot","family":"Nimanong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siwaporn","family":"Chainuvati","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8334-0267","authenticated-orcid":false,"given":"Phunchai","family":"Charatcharoenwitthaya","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawesak","family":"Tanwandee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Watcharasak","family":"Chotiyaputta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"ref_1","unstructured":"Polaris Observatory Collaborators (2018). Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: A modelling study. Lancet Gastroenterol. Hepatol., 3, 383\u2013403."},{"key":"ref_2","first-page":"773","article-title":"Access to Treatment for Hepatitis B Virus Infection\u2014Worldwide, 2016","volume":"67","author":"Hutin","year":"2018","journal-title":"Am. J. Transplant."},{"key":"ref_3","unstructured":"WHO (2016). Global Health Sector Strategy on Viral Hepatitis 2016\u20132021. Towards Ending Viral Hepatitis, World Health Organization."},{"key":"ref_4","unstructured":"WHO (2022, March 14). Global Hepatitis Report 2017. Available online: http:\/\/apps.who.int\/iris\/handle\/10665\/255016."},{"key":"ref_5","doi-asserted-by":"crossref","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"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"EASL (2017). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J. Hepatol., 67, 370\u2013398.","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"ref_7","doi-asserted-by":"crossref","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."},{"key":"ref_8","unstructured":"THASL (2022, March 14). Thailand Practice Guideline for Management of Chronic Hepatitis B and C 2015. Available online: https:\/\/thasl.org\/wp-content\/uploads\/2019\/09\/25.Thailand-guideline-for-management-of-CHB-and-CHC-2015.pdf."},{"key":"ref_9","unstructured":"WHO (2022, March 31). Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Available online: http:\/\/whoint\/hiv\/pub\/hepatitis\/hepatitis-b-guidelines\/en\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.jhep.2018.05.024","article-title":"Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa","volume":"69","author":"Shimakawa","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jhep.2020.06.031","article-title":"Validation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age","volume":"73","author":"Howell","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.jhep.2019.03.008","article-title":"Clinical utility of TREAT-B score in African and non-African HBV-infected patients living in Europe","volume":"70","author":"Yoshida","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.jhep.2019.06.024","article-title":"Performance of two simplified HBV treatment criteria (TREAT-B score and WHO guidelines) in Burkina Faso, West Africa","volume":"71","author":"Shimakawa","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.jhep.2019.04.006","article-title":"A novel score to select patients for treatment in chronic hepatitis B: Results from a large Ethiopian cohort","volume":"71","author":"Johannessen","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Vinikoor, M.J., Sinkala, E., Kanunga, A., Muchimba, M., Zanolini, A., Saag, M., Pry, J., Nsokolo, B., Chisenga, T., and Kelly, P. (2020). Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227041"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1072","DOI":"10.1093\/cid\/ciaa1814","article-title":"Assessment and Simplification of Treatment Eligibility Among Patients With Chronic Hepatitis B Infection in Vietnam","volume":"73","author":"Shimakawa","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.jhep.2020.07.010","article-title":"Reply to: \u201cValidation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age\u201d","volume":"73","author":"Shimakawa","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1136\/gutjnl-2015-309892","article-title":"Natural history of chronic HBV infection in West Africa: A longitudinal population-based study from The Gambia","volume":"65","author":"Shimakawa","year":"2016","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s12072-008-9050-9","article-title":"Natural history and clinical management of chronic hepatitis B virus infection in children","volume":"2","author":"Chang","year":"2008","journal-title":"Hepatol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/S1470-2045(11)70077-8","article-title":"Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): Development and validation of a predictive score","volume":"12","author":"Yang","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1200\/JCO.2009.26.2675","article-title":"Clinical scoring system to predict hepatocellular carcinoma in chronic hepatitis B carriers","volume":"28","author":"Wong","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jhep.2013.09.029","article-title":"Liver stiffness-based optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B","volume":"60","author":"Wong","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1002\/sim.1742","article-title":"Presentation of multivariate data for clinical use: The Framingham Study risk score functions","volume":"23","author":"Sullivan","year":"2004","journal-title":"Stat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4097\/kja.21209","article-title":"Receiver operating characteristic curve: Overview and practical use for clinicians","volume":"75","author":"Nahm","year":"2022","journal-title":"Korean J. Anesthesiol."},{"key":"ref_25","unstructured":"Shreffler, J., and Huecker, M.R. (2020). StatPearls, StatPearls Publishing."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.jhep.2015.11.035","article-title":"PAGE-B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5-year antiviral therapy","volume":"64","author":"Papatheodoridis","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jhep.2018.07.018","article-title":"Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy","volume":"69","author":"Kim","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jhep.2017.07.033","article-title":"Toronto HCC risk index: A validated scoring system to predict 10-year risk of HCC in patients with cirrhosis","volume":"68","author":"Sharma","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1055\/s-0033-1345716","article-title":"Global perspective on the natural history of chronic hepatitis B: Role of hepatitis B virus genotypes A to J","volume":"33","author":"Liu","year":"2013","journal-title":"Semin. Liver Dis."},{"key":"ref_30","first-page":"601","article-title":"Do we need to determine viral genotype in treating chronic hepatitis B?","volume":"17","author":"Cooksley","year":"2010","journal-title":"J. Viral. Hepat."},{"key":"ref_31","first-page":"559","article-title":"Geographic variation in viral load among hepatitis B carriers with differing risks of hepatocellular carcinoma","volume":"7","author":"Evans","year":"1998","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jhep.2010.06.031","article-title":"Profiles of HBV DNA in a large population of Chinese patients with chronic hepatitis B: Implications for antiviral therapy","volume":"54","author":"Fung","year":"2011","journal-title":"J. Hepatol."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:52:32Z","timestamp":1760122352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,10]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["v15030724"],"URL":"https:\/\/doi.org\/10.3390\/v15030724","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,10]]}}}