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Hepatitis B Virus-Related Care Quality In Patients With Hepatitis B/Hiv Coinfection Versus Hepatitis B Monoinfection: A National Cohort Study.

BACKGROUND
Guideline-adherent hepatitis B virus (HBV) care is critical for patients with HBV, particularly HBV-HIV co-infected patients given increased risks of liver-related complications. However, a comprehensive assessment of HBV-related care in HBV-HIV coinfected patients is lacking.


METHODS
We retrospectively assessed adherence to HBV-related care guidelines in all patients with HBV-HIV co-infection and HBV monoinfection (HBV-M) in the national Veterans Health Administration healthcare system in 2019.


RESULTS
We identified 1,021 patients with HBV-HIV among 8,323 veterans with chronic HBV. Adherence to HBV guidelines was similar or better in HBV-HIV versus HBV-M, including HBV treatment (97% vs. 71%), biannual hepatocellular carcinoma (HCC) surveillance (55% vs. 55%) for patients with cirrhosis, HAV screening (69% vs. 56%), HCV screening (100% vs. 99%), and on-therapy ALT monitoring (95% vs. 96%).Compared to those seeing gastroenterology (GI) or infectious diseases (ID) providers, patients without specialty care were less likely to receive antiviral treatment (None:39%, GI:80%, ID:84%) or HCC surveillance (None: 16%, GI: 66%, ID:47%). These findings persisted in multivariable analysis. Compared with ID care alone, a higher proportion of HBV-HIV patients seen dually by GI and ID received HCC surveillance (GI+ID:73% vs. ID:31%) and on-therapy HBV-DNA monitoring (GI+ID: 82%, ID: 68%).


CONCLUSIONS
HBV-HIV patients received similar or higher rates of guideline-adherent HBV-related care than HBV-M patients. HBV-HIV patients under dual GI and ID care achieved higher quality care compared to ID care alone. Specialty care was independently associated with higher quality HBV care in HBV-HIV and HBV-M patients.