Access to treatment of acute hepatitis b and chronic hepatitis b acute exacerbation

Abstract

Objectives: Acute hepatitis B (AHB) and chronic hepatitis B acute exacerbation (CHBAE) can lead to liver failure, necessitating careful monitoring and urgent intervention. This study aimed to evaluate patients diagnosed with AHB and CHBAE, the antivirals initiated, and the methods of accessing these treatments. Materials and Methods: This study included patients monitored at our hospital over a 5 year period with diagnoses of AHB and CHBAE. Clinical symptoms of the patients, potential etiologies leading to infection or exacerbation, laboratory values, possible diagnoses, indications for antiviral treatment, methods of treatment access, and disease course were retrospectively evaluated. Results: Seven patients diagnosed with AHB and 12 with CHBAE were included in the study. Antiviral therapy was initiated in nine patients (47.4%). Among these patients, four began antivirals for coagulopathy, one for pregnancy, one for cessation of previously used antivirals for CHB, and three for ongoing liver function test abnormalities and hepatitis B virus-DNA positivity. Only two patients had swift access to treatment through health insurance coverage, while others pursued alternative routes, such as off-label drug approval. None of the patients developed fulminant hepatitis. Conclusion: The treatment indications for AHB are clearly established based on the guidelines. Some studies recommend initiating treatment for all CHBAE cases, whereas others suggest treatment only when signs of liver failure are present. Access to treatment for patients who require urgent intervention may be delayed due to non-compliance with healthcare reimbursement regulations. Adjustments in health insurance coverage for antiviral therapies are necessary to mitigate such delays.