Chronic hepatitis B, which is caused by infection with the hepatitis B virus (HBV), disproportionately affects people in the United States who are of Asian descent. An estimated 2 million people in America are living with the disease, and Asian Americans account for over half of this prevalence. First-generation Asian Americans are at the highest risk. It’s estimated that as many as one in 10 foreign-born Asians are living with chronic hepatitis B, a rate more than 20 times greater than that of the general population. This discrepancy reflects the high incidence of HBV infection in several Asian countries, where immunization against the disease is not yet standard practice. As a result of chronic HBV infection, Asian Americans are at greater risk of developing liver cancer, and are 2.4 times more likely than Caucasians to die from liver cancer.
New Survey on Screening Practices
Despite clear evidence of the heavy burden of hepatitis B on Asians, a recent survey my colleagues and I presented at the 2009 International Symposium on Viral Hepatitis and Liver Disease showed that many physicians serving the Asian-American community fail to routinely screen for HBV. The study—which was based on data from 233 Asian-American physicians in the New York, Los Angeles, San Francisco, Houston, and Chicago metropolitan areas—demonstrated that only 50% of doctors reported routinely screening all of their Asian-American patients for HBV. In addition, 40% of doctors surveyed said they had screened no more than a quarter of Asian-American patients. The most frequently-cited reason for not offering screening was the perception that patients were not at risk for the virus.
These low levels of HBV screening in the Asian-American community suggest that an alarming number of infected individuals are going undiagnosed and untreated. According to some estimates, up to two-thirds of Asian Americans living with chronic hepatitis B do not know their HBV status. This can endanger not only their own personal health but also that of their partners and families.
Updated CDC Recommendations
To better diagnose people with chronic hepatitis B, the CDC issued guidelines in September 2008 (Table). It recommends that all foreign-born Asian Americans be tested for HBV and referred to medical care as needed. Clinicians should also be aware that there is no simple cure for HBV, but it can be treated effectively when it’s diagnosed early. Seven FDA-approved medicines are available for chronic HBV, including once-daily oral antiviral therapies that suppress viral replication. Especially for the Asian-American population, it’s critical that physicians implement the CDC guidelines on routine HBV screening. Stepping up HBV detection and treatment for those at greatest risk may greatly reduce the morbidity and mortality associated with this disease.
Danny Chu, MD, has indicated to Physician’s Weekly that he has worked as a consultant and paid speaker for Gilead, Bristol-Myers Squibb, and Novartis.
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