Title: Chronic HBV infection in Toronto, Canada: Tale of two clinics

Background: CY and DW both have a longstanding interest in chronic HBV infection. Both CY and DW have similar opinions on HBV management that do not always agree with guidelines. The clinic adopted Epic EMR in June 2022, which potentially allows for summary of the patients in these clinics.

Purpose: Describe two clinics where management is different from existing and proposed guidelines: not everyone is treated, treatment can be stopped, not all with cirrhosis needs treatment.

Method: SlicerDicer module of Epic was used to identify those with chronic HBV infection in two different clinics run by DW and CY.

Result(s): From June 6, 2022 to July 15, 2023, N=3,309 individual patients have been assessed, of which 1,769 (53.4%) were being followed for chronic HBV infection. More of CY’s patients had HBV (83.2%) compared to DW (45.6%). CY has not yet adopted universal testing for HDV. More of CY’s patients were on antiviral therapy (67.2%) compared to DW (42.4%). Otherwise, the two groups were very similar (see table). Proportion of those who remain HBeAg positive or in the Immune Tolerance phase has decreased to very low levels, likely due to successful birth vaccination initiatives in Asia.

Conclusion(s): Chronic HBV is common and can be managed without longterm antiviral therapy.