Are US Veterans Being Appropriately Tested and Treated for Hepatitis B?

BOSTON, Nov. 8, 2014 /PRNewswire/ -- Attendees of the annual meeting of the American Association for the Study of Liver Diseases (AASLD) listened to the results of a study on the adherence to its practice guidelines on testing for hepatitis B virus (HBV). Drs. Marina Serper, Kimberly Forde, and David E. Kaplan, of the University of Pennsylvania and Philadelphia VA Medical Center, examined the VA's Corporate Data Warehouse and concluded that the rates of serologic testing for HBV conducted by the VA were suboptimal as recommended by the AASLD practice guideline.

"While other chronic viral infections such as hepatitis C and HIV have received tremendous educational efforts," said Dr. Kaplan, principal investigator for the study, "hepatitis B has received far less attention, particularly outside communities with high numbers of immigrants from endemic regions."

Although only 1.0 percent (26,727) Veterans tested positive for hepatitis B, the study revealed that HBV infection is twice as common in the Veteran population as in the general population of the country.

Hepatitis B Surface Antigen (HBsAg) is the first test for detecting hepatitis B, but a positive result requires additional testing according to the AASLD practice guidelines on hepatitis B. Of the more than 2.5 million Veterans who had the HBsAg test, Dr. Serper's study identified 26,727 Veterans who tested positively. Of that group, the follow-up tests recommended by AASLD were not performed as frequently as recommended. In addition, those who were further tested received antiviral therapy only 25 percent of the time.

"Overall, 25 percent of individuals received antiviral therapy. Of those individuals that we can determine ought to be treated based on HBeAg, ALT, and HBV DNA criteria, only about 60 percent of individuals for whom treatment would likely be appropriate actually receive treatment. Individuals referred to a specialist were significantly more likely to receive treatment. Given low referral rates, these data are not surprising," said Dr. Kaplan.

Dr. Kaplan was asked to speculate about practice guideline adherence in the US population based on what's happening at the VA, and he said, "We suspect that in the baby boomer population there is a significant population of injection drug use-related chronic HBV that is undiagnosed and will not be captured by current USPSTF screening guidelines. Not only is there under-diagnosis, the majority -- up to 70 percent -- of screening HBsAg tests are not followed by referral from primary care to GI or ID providers with expertise in treatment decisions."

The study concluded that follow-up serologic testing for those who tested positive for HBV Surface Antigen and adherence to antiviral treatment recommendations was low, suggesting that provider education and improvements in clinical processes are needed to test and treat Veterans for hepatitis B.

When asked to address the need for testing, Dr. Kaplan said, "Appropriate serological testing is critical for determining whether or not an individual patient meets AASLD treatment criteria for HBV." Dr. Kaplan also addressed the importance of access to antiviral therapy, "Our and other data definitively demonstrate that antiviral therapy in appropriate individuals has a significant impact on mortality, hepatic decompensation, and HCC development. Improving adherence with guidelines is likely therefore to reduce death and healthcare costs," concluded Dr. Kaplan.

Abstract title:
Serologic testing rates among US veterans with hepatitis B

AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in Boston, November 7-11, will bring together more than 9,000 researchers from 55 countries.

A pressroom will be available from November 7 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.

Press releases and all abstracts are available online at www.aasld.org.

Media Contact: Gregory Bologna
703-299-9766
[email protected]
Press Room: November 7 – 11, 2014
Hynes Convention Center, Boston, MA
Telephone: 617-954-2977

Researcher: Marina Serper, MD MS
Email: [email protected]
Phone: 215-823-5800 x7401 

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SOURCE American Association for the Study of Liver Diseases

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http://www.aasld.org