Lai JCT, Wong VWS, Yip TCF, et al. - Assessment of the secular trend of treatment uptake in the territory-wide chronic hepatitis B (CHB) cohort revealed increasing treatment uptake rates over time in Hong Kong from 2000 to 2017. Patients avoid receiving antiviral treatment, even if treatment indication is fulfilled, when they show less advanced liver disease as indicated by normal platelet count. This highlights the relevance of recognizing to non-cirrhotic patients with significant liver fibrosis.

• Included were 135,395 CHB patients; in four study periods (2000-2004, 2005-2009, 2010-2013 and 2014-2017), the treatment criteria were fulfilled by 1,493/12,472 (12.0%), 7,416/43,426 (17.1%), 10,129/46,559 (21.8%), 8,051/32,938 (24.4%) patients, respectively.

• In non-cirrhotic patients, the main factors for treatment indication were high fibrosis indices (APRI, FIB-4 and Forns indices), with over 90% fulfilling treatment criteria due to high fibrosis indices alone.

• Antiviral treatment initiation was observed in less than 60% of those fulfilling treatment criteria by high fibrosis indices.

• In patients fulfilling treatment criteria, there was an independent correlation of normal platelet count with not initiating antiviral treatment.