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Barriers to Treatment of Hepatitis B in an Urban Chinatown Community

Malespin, Miguel MD; Wong, Shirley MD; Siqueira, Fabiolla MD; Luc, Brian MD; Ravaee, Benjamin MD; Vainder, Charles MD; Cotler, Scott J. MD

Journal of Clinical Gastroenterology: September 2012 - Volume 46 - Issue 8 - p e66–e70
doi: 10.1097/MCG.0b013e31824e159c
ONLINE ARTICLES: Original Articles

Goals: To evaluate the net effect of a concerted effort to treat hepatitis B virus (HBV) in a Chinese immigrant population, including barriers to initiating and continuing therapy and antiviral efficacy.

Background: Oral antiviral agents for HBV achieve high rates of viral suppression. However, there is limited information about the impact of attempts to treat HBV in high prevalence immigrant communities.

Methods: Sixty-nine patients were identified in an urban Chinatown Internal Medicine practice who had indications for treatment of HBV. A coordinated effort was made to provide antiviral therapy to these patients. Barriers to starting treatment and reasons for discontinuation were categorized on the basis of a systematic review of medical records. Suppression of HBV DNA to undetectable levels was considered a treatment response.

Results: Twenty-six percent (18/69) of patients did not start medication because of failure to follow-up or treatment refusal. Oral antiviral therapy was initiated in 74% (51/69) of cases and 38 of 39 patients who remained on treatment achieved viral suppression. Twelve patients discontinued medication because of social, economic, or other reasons. In total, 55% (38/69) of treatment candidates achieved undetectable HBV DNA levels on therapy.

Conclusions: Although oral antiviral therapy was highly effective in achieving viral suppression in patients who were maintained on treatment, only 55% of treatment candidates reached this endpoint. Barriers to care kept nearly one half of patients from initiating or continuing therapy. A multidisciplinary approach including education and social and financial support is needed to maximize the benefit of available HBV treatment in this urban immigrant population.

Department of Medicine, Section of Hepatology, University of Illinois, Chicago, IL

Supported by the Walter Payton Center Guild, University of Illinois, Chicago.

S.J.C. has served as a speaker for Brystol Myers and Gilead. The other authors declare that they have nothing to disclose.

Reprints: Scott J. Cotler, MD, Department of Medicine, Section of Hepatology, University of Illinois, 840S. Wood St, MC 787, Chicago, IL 60612 (e-mail:

Received October 19, 2011

Accepted February 1, 2012

© 2012 Lippincott Williams & Wilkins, Inc.