Literature DB >> 19929923

Evidence for the insufficient evaluation and undertreatment of chronic hepatitis B infection in a predominantly low-income and immigrant population.

Chin W Jung1, Jennifer Tan, Nelly Tan, Melissa N Kuo, Ashwin Ashok, Samantha J Eells, Loren G Miller.   

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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Year:  2009        PMID: 19929923     DOI: 10.1111/j.1440-1746.2009.06023.x

Source DB:  PubMed          Journal:  J Gastroenterol Hepatol        ISSN: 0815-9319            Impact factor:   4.029


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