The uptake of antiviral treatment for patients with chronic hepatitis B (CHB) has been suboptimal. We aimed to determine the secular trend of treatment uptake in the territory-wide CHB cohort in Hong Kong from 2000 to 2017, and the factors for no treatment despite fulfilling treatment criteria.
CHB patients under public clinics and hospitals were identified through electronic medical records. The treatment indications were defined according to the Asian-Pacific guidelines published at the time of patients’ first appearance in four periods: 2000-2004, 2005-2009, 2010-2013 and 2014-2017. 135,395 CHB patients were included; 1493/12472 (12.0%), 7416/43426 (17.1%), 10129/46559 (21.8%), 8051/32938 (24.4%) patients fulfilled treatment criteria in the four periods, respectively. The treatment uptake rate increased with time: 35.1%, 43.4%, 60.2% and 68.6% respectively. High fibrosis indices (APRI, FIB-4 and Forns indices) appeared to be the main factors for treatment indication in non-cirrhotic patients, with over 90% fulfilling treatment criteria due to high fibrosis indices alone. Of those fulfilling treatment criteria by high fibrosis indices, less than 60% of patients (25.2%, 36.1%, 46.0% and 58.9% respectively) had antiviral treatment initiated. Normal platelet count (odds ratio 0.42, p<0.001) was the independent factor associated with not initiating antiviral treatment in patients fulfilling treatment criteria.
Treatment uptake rates have been increasing over time. Normal platelet count, which reflects less advanced liver disease, precludes patients from receiving antiviral treatment even if treatment indication is fulfilled. Hence the importance to identify non-cirrhotic patients with significant liver fibrosis should be emphasized.

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