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Gap in Hepatitis B Diagnosis and Treatment

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Find out about a report that highlights some large, seemingly preventable gaps in Hepatitis B care.

The healthcare community is urged to step up their ability to detect and treat chronic viral Hepatitis B. That is because not nearly enough people are benefiting from Hepatitis B’s medical advances. Besides a need for better screening practices and treatment education, there is also a demand for comprehensive medical care.

Complicating Hepatitis B diagnosis is the fact that many people live with this virus for decades without any detectable symptoms. It may seem bizarre or even paranoid to go digging around to detect potential health issues without any indication of a problem. However, Hepatitis B represents an exception to this norm.

The enormous cost of the Hepatitis B drugs, long required treatment time frame and potentially severe side effects can easily turn many people off from receiving treatment. Assuming a person even has health insurance and can get his or her therapy paid for, preventing Hepatitis B from progressing to advanced liver disease is typically considered to be worth the medications’ inconvenience and expense.

The disparities between who has Hepatitis B, who knows they have Hepatitis B and who receives treatment for Hepatitis B have some serious implications:

  • Not knowing you have Hepatitis B greatly increases the chances of unintentionally spreading this communicable disease. The Centers for Disease Control and Prevention (CDC) estimates that 65 percent of all individuals infected with Hepatitis B are unaware of their infection.
  • Not receiving treatment for Hepatitis B greatly increases the chance that the virus will progressively damage the liver. More specifically, chronic infection with Hepatitis B is a major risk factor for development of end-stage liver disease, including cirrhosis, liver failure and primary liver cancer.
  • A majority of liver cancers result from chronic viral Hepatitis B or C infection. According to Ms. Lorren Sandt, Chair of the National Viral Hepatitis Roundtable (NVHR) and Executive Director of Caring Ambassadors Program, based in Portland, OR, “Liver cancer is one of the three fastest growing cancer diagnoses in the U.S.” Sandt says that early detection and treatment of chronic viral hepatitis will stop the spread of liver cancer.

Looking at the numbers associated with chronic Hepatitis B infection showcases the dramatic discrepancy:

  • Experts estimate that 1.4 to 2 million Americans have chronic Hepatitis B.
  • Out of the 1.4 to 2 million Americans, only around 600,000 have been diagnosed.
  • Out of the 600,000 people diagnosed with chronic Hepatitis B, only around 250,000 are referred for appropriate care.
  • Out of the 600,000 people diagnosed with chronic Hepatitis B, about 400,000 are actually eligible for treatment according to current guidelines.
  • Out of the approximate 400,000 people eligible for chronic Hepatitis B treatment, only about 50,000 people are currently on Hepatitis B therapy.

A report published in a June 2011 edition of the Journal of Viral Hepatitis examined the possible reasons behind the gaps in Hepatitis B management. Upon reviewing relevant data, Chari Cohen from the Hepatitis B Foundation and colleagues from the CDC and other public health agencies and treatment facilities proposed the following explanations for the disparities between Hepatitis B infection, diagnosis and treatment:

  1. Ethnic group – Many people (doctors and patients) are unaware that Asians/Pacific Islanders are an ethnic group at an extremely high risk of Hepatitis B infection. Regardless of whether symptoms exist, knowing that these ethnicities are at high risk could facilitate better screening and diagnosis.
  2. Treatment reluctance – Due to its high cost and risk of side effects, many who know they have Hepatitis B are reluctant to begin treatment. This is especially applicable when the patient currently feels healthy.
  3. Health coverage – More than some other ethnicities, Asians/Pacific Islanders report a lower use of the healthcare system and are less likely to have health insurance.

The authors of this report recognize that the largest barriers to chronic Hepatitis B care are threefold:

  1. Awareness of who is at high risk
  2. Screening and diagnosis
  3. Access to care

There is sufficient evidence indicating that a relatively small portion of Americans with chronic Hepatitis B are being diagnosed and treated for it. By improving Hepatitis B screening (especially within high risk ethnic populations), educating the public about the importance of treatment and expanding access to comprehensive healthcare, this common, damaging liver virus will reach end-stage liver diseases less and less frequently.

References:, Is chronic hepatitis B being undertreated in the United States?, C. Cohen, et al, Retrieved July 30, 2011, Journal of Viral Hepatitis, June 2011., Most Liver Cancer Caused By Undiagnosed Viral Hepatitis C and B, Retrieved July 30, 2011, Doc Misha, 2011., Is Hepatitis B Under-treated in U.S.?, Liz Highleyman, Retrieved July 30, 2011,, 2011., Hepatitis Day Event to Screen Asian Americans July 30, Retrieved July 30, 2011, SanTan Sun News, 2011.


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