title: A significant proportion of patients with chronic hepatitis B who are candidates for antiviral treatment are untreated: A region-wide survey in Italy.
abstract: BACKGROUND
  Between 350 and 400 million people worldwide have chronic hepatitis B virus (HBV) infection, and in Italy this figure is 1% to 2% in the general population. In clinical practice, however, it is not known how many patients chronically infected by HBV and eligible for antiviral therapy are not treated.
  
  
  OBJECTIVE
  To characterize the clinical picture of untreated HBV patients, and to assess whether current experts' recommendations for treatment are actually applied.
  
  
  METHODS
  We evaluated 362 patients chronically infected by HBV alone who were followed for at least 1 year at tertiary referral centers in Liguria region, Italy. Patients' data were evaluated on the basis of the Panel of Experts algorithm for the management of HBV [ie, HBV DNA levels > or =20,000 IU/mL in hepatitis B e antigen (HBeAg)-positive patients, HBV DNA levels > or =2000 IU/mL in HBeAg-negative patients, and evidence of biochemical and/or histologic activity of disease in both groups].
  
  
  RESULTS
  One-hundred and sixteen viremic chronic hepatitis B disease patients were not on antiviral therapy (33 HBeAg positive, 83 HBeAg negative). Serum HBV DNA was > or =20,000 IU/mL and > or =2000 IU/mL in 32 HBeAg-positive and 54 HBeAg-negative patients, respectively, and disease was present in 59 of these 86 patients. Treatment was not indicated in 10 of 59 patients, and had been planned in 8 (4 HBeAg positive), thus 84% potential treatment candidates (41 of 49 patients) were not treated.
  
  
  CONCLUSIONS
  Evaluation of a large series of patients chronically infected by HBV alone identified a significant proportion of patients who are actually untreated despite being potential candidates for antiviral therapy.
authors.affiliation: Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Francesco
authors.initials: F
authors.lastname: Torre
authors.forename: Monica
authors.initials: M
authors.lastname: Basso
authors.forename: Marcello
authors.initials: M
authors.lastname: Feasi
authors.forename: Silvia
authors.initials: S
authors.lastname: Boni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Grasso
authors.forename: Pasqualina
authors.initials: P
authors.lastname: De Leo
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Dodi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Marazzi
authors.forename: Emilio
authors.initials: E
authors.lastname: Azzola
authors.forename: Valentina
authors.initials: V
authors.lastname: Bartolacci
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percario
authors.forename: Andrea
authors.initials: A
authors.lastname: Beltrame
authors.forename: Paolo
authors.initials: P
authors.lastname: Borro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Antonino
authors.initials: A
authors.lastname: Picciotto