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  • Title: Evidence for the insufficient evaluation and undertreatment of chronic hepatitis B infection in a predominantly low-income and immigrant population.
    Author: Jung CW, Tan J, Tan N, Kuo MN, Ashok A, Eells SJ, Miller LG.
    Journal: J Gastroenterol Hepatol; 2010 Feb; 25(2):369-75. PubMed ID: 19929923.
    Abstract:
    BACKGROUND AND AIM: Many physicians remain unaware of contemporary treatments for chronic hepatitis B (HBV) infection and do not treat their HBV-infected patients or refer them for treatment. The aim of the present study was to determine the rates of laboratory evaluation and treatment of HBV infection in a predominantly low-income and immigrant population. METHODS: We identified adult patients who tested positive for hepatitis B surface antigen between 1 January 1994 and 30 April 2006. We reviewed patients' medical records to determine two outcomes: (i) receipt of pretreatment evaluation of HBV infection; and (ii) receipt of HBV treatment. We then examined clinical and demographic factors associated with these outcomes. RESULTS: Twenty-eight percent of 1231 HBV surface antigen-positive patients received additional laboratory evaluation of their infection. In a multivariate analysis, receipt of a HBV evaluation was independently associated with (P < 0.05) female sex, longer duration of HBV infection, more visits to a gastroenterology clinic and less recent health-care contact. Data on treatment were available for 56% of patients; among these, 16% received HBV treatment. In the multivariate analysis, receipt of HBV treatment was independently associated with (P < 0.05) HIV co-infection, receipt of liver biopsy, testing for hepatitis B e antigen or HBV DNA, longer duration of HBV infection, more visits to a gastroenterology clinic and more recent health-care contact. When excluding HIV-infected patients, only 10% of patients received HBV treatment. CONCLUSIONS: After the diagnosis of HBV infection, few patients in our population received laboratory evaluation to determine eligibility for HBV treatment. Furthermore, only a small percentage received HBV treatment. Further research needs to be done to validate these findings in other populations and understand barriers to receiving HBV treatment.
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