B Under-treated in U.S.?
As few as 5% of the approximately 1.4 to 2.0 million people
with chronic hepatitis B in the U.S. are tested, enter
care, and are successfully treated, according to a recent
hepatitis B virus (HBV) infection is a major risk factor for
liver cirrhosis, hepatocellular carcinoma, and end-stage liver
failure. Disease progression typically takes decades, however,
and many people show no symptoms until they develop advanced
there are now 5
antiviral drugs, plus interferon alfa, approved in the
U.S. for chronic hepatitis B treatment, much remains to be
learned about who accesses therapy and the types of outcomes
described in the June
2011 Journal of Viral Hepatitis, Chari Cohen from
the Hepatitis B Foundation and colleagues from the Centers
for Disease Control and Prevention and other public health
agencies and treatment facilities reviewed data about how
many people are living with chronic hepatitis B and how many
are screened and treated, with an emphasis on disparities
between segments of the U.S. population.
1.4 and 2 million people in the U.S. have chronic hepatitis
suggest that only 20% to 30% of individuals with HBV -
about 600,000 - have been diagnosed.
indicate that a majority of Asians and Pacific Islanders,
gay and bisexual men, and injection drug users are unaware
of their HBV status.
Fewer than half of people diagnosed with chronic hepatitis
B, or approximately 200,000 to 300,000 patients, are referred
for appropriate care.
estimated 300,000 to 500,000 individuals with chronic
HBV infection are eligible for treatment according to
only 50,000 people -- or about 10% of those eligible --
are currently receiving prescription drugs for hepatitis
findings from a Hepatitis B Foundation study suggest that
no more than 80,000 people have been treated with FDA-approved
HBV drugs over the past 10 years in the U.S.
together, only an estimated 4% to 5% of people with chronic
hepatitis B are screened, get into care, receive prescription
drugs, and are successfully treated or remain in treatment.
at possible reasons for the wide gap between the number of people
with chronic hepatitis B and the number who receive treatment, the
study authors found that explanations include the large proportion
of infected individuals who have not been screened and therefore
remain undiagnosed, as well as lack of access to care. Many people
with hepatitis B have inadequate health insurance, insufficient
education about hepatitis B, and do not receive referrals to appropriate
medical care -- problems that appear to especially impact populations
with a disproportionately high burden of HBV infection.
only about 50,000 people receiving treatment, "the largest
barriers to care are most likely at the level of patient awareness,
diagnosis, and access to care," the researchers wrote. "These
appear to be the 'slow' steps in the process; once a patient is
diagnosed and able to access caregivers, they appear to have a fairly
good chance of receiving appropriate treatment."
people are unaware of their risk factors for HBV infection -- such
as belonging to a high-risk ethnic group -- and providers also lack
knowledge about which groups to screen and treat, they continued.
In addition, some individuals are reluctant to undergo long-term
treatment, with its high cost and risk of side effects, especially
when they feel healthy. In general, the authors noted, Asians/Pacific
Islanders report lower use of most health care services and are
less likely to have a source of ongoing health care, a situation
exacerbated by limited English proficiency.
our proposed estimates rely upon limited data and assumptions, the
overwhelming body of evidence suggests that only a minority of chronic
HBV-infected patients in the United States are being diagnosed and
receiving appropriate treatment," the researchers concluded.
"As chronic HBV infection and primary liver cancer rates in
the United States continue to rise, research and intervention efforts
that explore and reduce barriers to care and improve rates of diagnosis,
management, and treatment are necessary to reduce the morbidity
and mortality associated with this serious liver infection in the
Investigator affiliations: Hepatitis B Foundation, Doylestown,
PA; Centers for Disease Control and Prevention, Epidemiology and
Surveillance Branch, Division of Viral Hepatitis, National Center
for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta,
GA; Alaska Native Medical Center, Liver Disease and Hepatitis, Anchorage,
AK; Children's Hospital and Research Center, Oakland, CA; California
Pacific Medical Center, Liver Transplant Program, San Francisco,
CA Fox Chase Cancer Center, Philadelphia, PA.
Cohen, SD Holmberg, BJ McMahon, et al. Is chronic hepatitis B being
undertreated in the United States? Journal of Viral Hepatitis