We investigated factors associated with rates of recommended monitoring of chronic hepatitis B (HBV) patients for viral DNA and alanine aminotransferase (ALT), as well as initiation of antiviral treatment among eligible patients, in a US cohort of patients under routine care. Patients were categorized by treatment indication: definite, equivocal, or ineligible. Baseline covariates included demographics and clinical characteristics, as well as specialist care status. “Recommended monitoring” was defined ≥1 ALT or HBV DNA test per year. Logit models, univariate then multivariable, were used to evaluate factors associated with monitoring and treatment.

Among 3830 patients, treatment was received by 67.5% (788/1168 patients) in the “definite” category, and 34.1% (208/610 patients) in the “equivocal” category, of whom 109 moved up to “definite” status at some point during follow-up. Sex, age, and specialist care were independently associated with receipt of treatment in “definite” patients. Routine monitoring rates were high prior to treatment in “definite/ treated” patients (ALT: 77%; DNA: 85%) but declined afterward (ALT 63%; DNA 36%). Rates of monitoring were lower in “definite/ untreated” patients (ALT: 48%; DNA: 32%). Among “equivocal/ treated” patients, lower age and comorbidity scores with associated with receipt of treatment; ALT monitoring rates were similar before and after treatment initiation (41% and 46%, respectively) while rates of DNA monitoring declined (55% and 29%). Monitoring among “treatment ineligible” patients was similar to those in the “equivocal” and untreated “definite” groups.

A large proportion of US HBV patients under routine care did not receive recommended annual laboratory monitoring, especially after initiation of antiviral treatment, and nearly one-third of patients with “definite” indications for antiviral therapy remained untreated.