High Prevalence of Cirrhosis in Adults With Chronic HBV at a Safety-Net Hospital

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Approximately 15% to 40% of patients with HBV will have cirrhosis or cirrhosis-related complications during their lifetime.
Approximately 15% to 40% of patients with HBV will have cirrhosis or cirrhosis-related complications during their lifetime.

Of adults with chronic hepatitis B virus (HBV) infection seen at a safety-net hospital, nearly 30% had cirrhosis at initial presentation, with older male patients being at the highest risk, according to a retrospective study published in the Journal of Clinical and Experimental Hepatology.1

Cirrhosis is a serious consequence of HBV infection that is associated with a financial burden of $13 billion in the United States.2,3 Delays in HBV and cirrhosis diagnosis are often more common in the underserved population, leading to greater morbidity and mortality.4-7 To evaluate rates and predictors of cirrhosis and cirrhosis-related complications among adults with chronic HBV, researchers evaluated 329 consecutive adults with chronic HBV who were seen from July 2014 to May 2016 at gastroenterology clinics in a large safety-net hospital system that provides medical care to an ethnically diverse indigent population.1 

They found that 27.7% had cirrhosis at presentation, 4.3% had ascites, 3.7% had variceal bleeding, 4.9% had hepatic encephalopathy, and 4.0% had hepatocellular carcinoma. Men were more likely to have cirrhosis and variceal bleeding at presentation than women. In addition, older age and a positive hepatitis B surface antigen test were associated with a greater risk for cirrhosis at presentation.

“In conclusion, among adults with chronic HBV at an ethnically diverse safety-net hospital system, nearly 30% of patients had cirrhosis at initial presentation, with the greatest risk seen in older male patients,” the investigators stated.1 In addition, “more studies are needed to better identify provider-specific and patient-specific factors that contribute to suboptimal HBV screening and management such that targeted interventions can improve HBV linkage to care and treatment.”

References

  1. Tang E, Torres S, Liu B, Baden R, Bhuket T, Wong RJ. High prevalence of cirrhosis at initial presentation among safety-net adults with chronic hepatitis B virus infection. J Clin Exp Hepatol. 2018;8:235-240.
  2. Grattagliano I, Ubaldi E, Bonfrate L, Portincasa P. Management of liver cirrhosis between primary care and specialists. World J Gastroenterol. 2011;17(18):2273-2282.
  3. Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol (N Y). 2011;7(10):661-671.
  4. Burman BE, Mukhtar NA, Toy BC, et al. Hepatitis B management in vulnerable populations: gaps in disease monitoring and opportunities for improved care. Dig Dis Sci. 2014;59(1):46-56.
  5. Mukhtar NA, Toy BC, Burman BE, et al. Assessment of HBV preventive services in a medically underserved Asian and Pacific Islander population using provider and patient data. J Gen Intern Med. 2015;30(1):68-74.
  6. Mukhtar NA, Kathpalia P, Hilton JF, et al. Provider, patient, and practice factors shape hepatitis B prevention and management by primary care providers. J Clin Gastroenterol. 2017;51(7):626-631.
  7. Shah SA, Chen K, Marneni S, et al. Hepatitis B awareness and knowledge in hepatitis B surface antigen-positive parturient immigrant women from West Africa in the Bronx, New York. J Immigr Minor Health. 2015;17(1):302-305.
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