Digestive Diseases and Sciences

, Volume 57, Issue 5, pp 1373–1383

Undertreatment of Asian Chronic Hepatitis B Patients on the Basis of Standard Guidelines: A Community-Based Study

  • Sue Zhang
  • Jessica T. Ristau
  • Huy N. Trinh
  • Ruel T. Garcia
  • Huy A. Nguyen
  • Mindie H. Nguyen
Original Article


Background and Objectives

Previous studies have found that a major proportion of patients with chronic hepatitis B (CHB) do not receive antiviral therapy. The objective of this study was to characterize treatment eligibility on the basis of current guidelines, determine whether eligible patients actually receive treatment, and examine associated predictors.


We conducted a retrospective study of patients who were evaluated for CHB at two community gastroenterology clinics between April 2007 and February 2009. Using criteria published by the American Association for the Study of Liver Diseases (AASLD) in 2007–2009 and by a panel of US hepatologists (US Panel) in 2006–2008, treatment eligibility was determined for the patients.


Of 612 consecutive CHB patients included, mean age was 44 ± 13 years, 54 % were male, and 99 % were Asian. Half (51 %) were eligible for treatment on the basis of the US Panel algorithm and 47 % of these patients also met AASLD treatment criteria. Overall, antiviral therapy was initiated for 50 % of eligible patients: 72 % of AASLD-eligible patients and 29 % of patients who were US Panel-eligible only. Independent predictors for actual treatment initiation were higher ALT for AASLD-eligible patients and higher ALT and older age for patients who were US Panel-eligible only. The leading reasons for nontreatment were further observation recommended by the physician, followed by loss of follow-up and patient refusal.


Approximately half of the CHB patients evaluated at community referral clinics met treatment criteria of at least one guideline; however, only about half received antiviral therapy within 12 months of presentation. Further studies are needed to optimize treatment of eligible CHB patients.


Chronic hepatitis B Hepatitis B virus Undertreatment Asian–American Hepatitis B treatment guidelines 



Chronic hepatitis B


Hepatocellular carcinoma


American Association for the Study of Liver Diseases


United States


Hepatitis B virus


Hepatitis B e antigen


Hepatitis C virus


Hepatitis D virus


Alanine aminotransferase


Upper limit of normal

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Sue Zhang
    • 1
    • 2
  • Jessica T. Ristau
    • 1
  • Huy N. Trinh
    • 1
    • 3
  • Ruel T. Garcia
    • 1
    • 3
  • Huy A. Nguyen
    • 3
  • Mindie H. Nguyen
    • 4
  1. 1.Pacific Health FoundationSan JoseUSA
  2. 2.David Geffen School of Medicine at the University of CaliforniaLos AngelesUSA
  3. 3.San Jose GastroenterologySan JoseUSA
  4. 4.Division of Gastroenterology and HepatologyStanford University Medical CenterPalo Alto, StanfordUSA

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