Objective: Diagnosis and treatment of chronic hepatitis B (CHB) have improved in recent years with introduction of new oral antiviral drugs. Aim of this study was to analyze general knowledge, therapeutic and diagnostic trends of physicians treating CHB in Spain.
Methods: A questionnaire was distributed to 692 physicians of the Spanish Association for the Study of the Liver. The questionnaire assessed habits in CHB management and approach to a pair of hypothetical CHB cases: HBeAg positive and HBeAg negative.
Results: One hundred and nineteen (17%) physicians answered the questionnaire. Most of them correctly identified indications for CHB treatment (95%), and had experience with lamivudine (89%), adefovir dipivoxil (84%) and interferon (76%), but only 45% knew the efficacy rate of these drugs. Seventy-six percent recommended pegylated interferon as initial treatment for HBeAg-positive patients, and 86% would treat HBeAg-negative patients with oral antiviral drugs (42% with lamivudine, 36% with adefovir dipivoxil, and 8% with entecavir). Hepatitis B virus (HBV)-DNA determination was used to monitor therapy by 74%, and only 24% used HBV drug resistance test. The only independent factor associated with adequate use of drugs and correct monitoring was experience of treating more than five patients per year. Antiviral prophylaxis for HBV carriers receiving immunosuppression was indicated by 78% of physicians. Physicians working at university hospitals were significantly more likely to recommend antiviral prophylaxis than physicians working at nonuniversity hospitals (86 vs. 65%; P=0.009).
Conclusion: CHB management decisions are not always based on scientific evidence. Continuous medical education could improve knowledge and management of CHB.