High Prevalence of Cirrhosis in Adults With Chronic HBV at a Safety-Net Hospital
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.”
- 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.
- 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.
- Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol (N Y). 2011;7(10):661-671.
- 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.
- 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.
- 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.
- 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.