BACKGROUND: Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA. METHODS: We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a "recent" 18-month study window (July 2009-December 2010), or as "ever" based on records dating to 1995. RESULTS: The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥ 1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment. CONCLUSIONS: Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.
BACKGROUND: Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA. METHODS: We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a "recent" 18-month study window (July 2009-December 2010), or as "ever" based on records dating to 1995. RESULTS: The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥ 1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment. CONCLUSIONS: Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.
Authors: Blaire E Burman; Nizar A Mukhtar; Brian C Toy; Tung T Nguyen; Alice Hm Chen; Albert Yu; Peter Berman; Hali Hammer; Daniel Chan; Charles E McCulloch; Mandana Khalili Journal: Dig Dis Sci Date: 2013-09-20 Impact factor: 3.199
Authors: Sue Zhang; Jessica T Ristau; Huy N Trinh; Ruel T Garcia; Huy A Nguyen; Mindie H Nguyen Journal: Dig Dis Sci Date: 2012-03-31 Impact factor: 3.199
Authors: Ellen T Chang; Theresa H M Keegan; Scarlett L Gomez; Gem M Le; Christina A Clarke; Samuel K S So; Sally L Glaser Journal: Cancer Date: 2007-05-15 Impact factor: 6.860
Authors: Andrew J Karter; Dean Schillinger; Alyce S Adams; Howard H Moffet; Jennifer Liu; Nancy E Adler; Alka M Kanaya Journal: Diabetes Care Date: 2012-10-15 Impact factor: 19.112
Authors: Henry J Pollack; Simona C Kwon; Su H Wang; Laura C Wyatt; Chau Trinh-Shevrin Journal: Cancer Epidemiol Biomarkers Prev Date: 2014-11 Impact factor: 4.254
Authors: Hannah M Lee; Joseph Ahn; W Ray Kim; Joseph K Lim; Mindie Nguyen; Calvin Q Pan; Donghee Kim; Ajitha Mannalithara; Helen Te; Huy Trinh; Danny Chu; Tram Tran; Jocelyn Woog; Anna S Lok Journal: Dig Dis Sci Date: 2018-09-20 Impact factor: 3.199
Authors: Nizar A Mukhtar; Priya Kathpalia; Joan F Hilton; Gene Lau; Albert Yu; Kevin Grumbach; Tung T Nguyen; Daniel Chan; Mandana Khalili Journal: J Clin Gastroenterol Date: 2017-08 Impact factor: 3.062
Authors: Andrew A Li; Donghee Kim; Won Kim; Pratima Dibba; Katherine Wong; George Cholankeril; Ira M Jacobson; Zobair M Younossi; Aijaz Ahmed Journal: J Viral Hepat Date: 2018-09-11 Impact factor: 3.728
Authors: Matthew S Chang; J Frank Wharam; Fang Zhang; Robert F LeCates; Emma Morton-Eggleston; Ruth E Tuomala; Anna E Rutherford; Muthoka L Mutinga; Karin L Andersson; Robert S Brown; Chinweike Ukomadu; Emily Oken Journal: J Clin Gastroenterol Date: 2019 Nov/Dec Impact factor: 3.062
Authors: Padmavathi Srivoleti; Allison L Yang; David X Jin; Peter A Banks; Julia McNabb-Baltar Journal: Dig Dis Sci Date: 2020-08-20 Impact factor: 3.199