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Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting

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Abstract

Background

Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA.

Methods

We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a “recent” 18-month study window (July 2009–December 2010), or as “ever” based on records dating to 1995.

Results

The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment.

Conclusions

Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.

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Abbreviations

CHB:

Chronic hepatitis B

HBV:

Hepatitis B virus

AASLD:

The American Association for the Study of Liver Diseases

GI:

Gastroenterologist

PCP:

Primary care provider

ID:

Infectious disease

HBeAg:

Hepatitis B e antigen

anti-HBe:

Hepatitis e antibody

HCC:

Hepatocellular carcinoma

HIV:

Human immunodeficiency virus

HCV:

Hepatitis C virus

sALT:

Standardized ALT

ULN:

Upper limit of normal

HBsAg:

Hepatitis B surface antigen

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Acknowledgments

This research was funded by Gilead Sciences, Inc. [awarded to MM]. Additional support was received through the Sylvia Allison Kaplan Research Award [MS].

Conflict of interest

Funding by Gilead Sciences, Inc. was awarded to Michele Manos. Norah Terrault has received grant support from Gilead Sciences, Inc., and served as a consultant for Bristol-Myers Squibb and Gilead Sciences, Inc.

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Authors and Affiliations

  1. Viral Hepatitis Registry, Kaiser Permanente Division of Research, Oakland, CA, USA

    Monika Sarkar, Valentina A. Shvachko, Joanna B. Ready, Mary Pat Pauly & M. Michele Manos

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA, 94143-0358, USA

    Monika Sarkar, Norah A. Terrault & Marion G. Peters

Authors
  1. Monika Sarkar
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  2. Valentina A. Shvachko
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  3. Joanna B. Ready
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  4. Mary Pat Pauly
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  6. Marion G. Peters
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  7. M. Michele Manos
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Correspondence to Monika Sarkar.

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Sarkar, M., Shvachko, V.A., Ready, J.B. et al. Characteristics and Management of Patients with Chronic Hepatitis B in an Integrated Care Setting. Dig Dis Sci 59, 2100–2108 (2014). https://doi.org/10.1007/s10620-014-3142-2

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  • DOI: https://doi.org/10.1007/s10620-014-3142-2

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