Hepatitis B virus markers in the foreign-born Chinese population of Los Angeles, California

Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA

BACKGROUND/RATIONALE

Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC.

RESULTS

Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center. Hepatitis B (HBV) infection was detected in up to 68% of Chinese, Korean, and Vietnamese patients, whereas 60% of Japanese patients had Hepatitis C (HCV) infection. Compared with HCC patients who presented with symptoms, those detected by surveillance had more tumors within the Milan and University of California, San Francisco (UCSF) criteria and more patients in Child-Turcotte-Pugh class A. On the basis of a predefined UCLA treatment algorithm, 83% of patients received surgical and/or loco-regional therapies. Compared with other treatments, orthotopic liver transplantation (OLT), and radiofrequency ablation had the highest overall patient survival (P<0.0001) and OLT has the highest disease free survival rates (P<0.0001). Independent baseline predictors for: (1) patient survival were HBV [hazard ratio (HR) 0.62, P=0.005], UCSF criteria (HR 0.46, P<0.0001), Child Turcotte Pugh class A (HR 0.57, P=0.005), alphafetoprotein per log10 increase (HR 1.26, P=0.0012), and alkaline phosphatase per log10 increase (HR 2.32, P=0.02); and for (2) disease free survival were UCSF criteria (HR 0.66 P=0.007), aspartate aminotransferase per log10 increase (HR 1.50, P=0.04), and age per year increase (HR=1.02, P=0.04). The 4 Asian subgroups had similar survival rates.

CONCLUSIONS

HBV and Hepatitis C were associated with over 90% of HCC cases in Asian Americans. HCC detected by surveillance identified more patients eligible for surgical and loco-regional therapies, which improved the overall and disease free survival.

Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): how can we do better for this special population?

Hepatitis B virus(HBV) infection is one of the major global public health problems. Based on the second National Health and Nutrition Examination Survey (NHANES II), it is estimated that 1.25 million people are HBV infected in the United States. However, Asian and Pacific Islander Americans (APIAs) were underrepresented in this survey, and studies on the community HBV screening reported 6-15% of HBV infection in this special population. This article systematically reviews recent research advances in the possible barriers of hepatitis B care in APIAs that can be classified into three major categories, i.e., provider-, patient-, and resource-related barriers. The article also provides an overview of multiple approaches to effectively reduce these barriers so that we can evolve better strategy and deliver appropriate care to this special population and eventually reduce health disparity of CHB in APIAs.

Provider knowledge and practice regarding hepatitis B screening in Chinese-speaking patients

BACKGROUND

The extent to which academic general medicine providers screen Chinese-speaking patients for hepatitis B virus (HBV) is not known.

METHODS

Retrospective cohort study of Chinese-speaking patients' HBV screening status and survey of providers' HBV knowledge/screening.

RESULTS

Most patients (65%) received HBV screening. Being screened was independently associated with marital status and years in the clinic. Providers with Asian language abilities and greater knowledge of HBV risk factors/guidelines were more likely to screen.

CONCLUSIONS

Chinese-speaking patients in this setting were underscreened for HBV. Providers underestimated the risks associated with Chinese ethnicity. Education is needed to improve risk assessment and guideline awareness.

Rising incidence of hepatocellular carcinoma: the role of hepatitis B and C; the impact on transplantation and outcomes

Hepatocellular carcinoma caused by hepatitis B and hepatitis C are global scourges but are likely to peak in incidence in the next 2 decades and then decline. Universal vaccination has been effective in stemming the incidence of chronic hepatitis B and early-onset HCC in regions of high endemicity where implemented, but preventive measures in HCV are not yet available. After the attrition of older affected generations, the incidence of HCC will likely decline rapidly. While no vaccine is currently available for hepatitis C, cases are projected to peak and decline because of a marked reduction in transmission as a result of behavioral modification and safeguarding of blood supplies. Until these epidemiologic projections come to pass, management of hepatocellular carcinoma will continue to become a progressively more frequently encountered clinical challenge. Therapy for chronic hepatitis may ameliorate but will not eliminate the development of tumors. The demand for orthotopic liver transplantation will continue to climb, and palliative therapies for non-resectable cases will require studies aimed at optimization of benefit. LDLT may remain an option for high-risk patients affording tumor-free survival for some otherwise terminal patients.

Twice daily nizatidine or ranitidine is superior to once daily dosing in elevating 24 h intragastric pH in patients with duodenal ulcer disease

The present study was performed in six asymptomatic patients with a history of resistant duodenal ulcers in whom 24 h intragastric pH, gastric juice pepsin and PGE2 concentrations, as well as serum gastrin concentrations, were measured. We wanted to compare the effects on these parameters of a single night time (q.h.s.) dose of nizatidine 300 mg (N1), nizatidine 300 mg b.i.d. (N2), ranitidine 300 mg q.h.s. (R1) or ranitidine 300 mg b.i.d. (R2) compared with placebo (P). During the night (22.00-08.00 h), all treatments gave a higher mean pH than P, but during the day (08.00-22.00 h) the mean pH was higher than P only for patients administered R2 and N2. Doubling the dose of nizatidine (N2 vs N1) or ranitidine (R2 vs R1) increased the mean daytime pH, but had no effect on night time pH. The daytime pepsin concentration was unaffected by H2-receptor antagonists, while night time pepsin was lower with R1 and R2, but not with N1 or N2. The night time gastrin concentration was unaffected by H2-receptor antagonists; doubling the dose of the H2-receptor antagonist (R2 vs R1 and N2 vs N1) increased daytime gastrin concentration. During the night, each treatment increased PGE2 concentration by at least six-fold compared with P. Thus, where it is therapeutically indicated to achieve greater suppression of acid secretion, doubling the total daily dose by dosing with twice daily versus once daily night time nizatidine or ranitidine is efficacious.

A cost comparison analysis for screening and vaccination of hospital personnel with high- and low-prevalence hepatitis B virus antibodies in California

We compared the cost of antibody screening and the projected cost for hepatitis B vaccination of antibody-negative individuals at hospitals with "high prevalence" and "low prevalence" rates for hepatitis B virus antibodies among their employees. The use of hepatitis B core antibody for screening and subsequent hepatitis B vaccination of antibody-negative personnel was most cost-effective for hospitals considered to have high prevalence for hepatitis B virus antibodies among its staff, although use of hepatitis B surface antibody in this setting only increased costs by 1.4%. In a hospital with low prevalence for hepatitis B virus antibodies among its staff, use of hepatitis B surface antibody and subsequent vaccination of antibody-negative individuals was the most cost-effective approach, while use of hepatitis B core antibody for the above purposes would have increased costs by 3.4%. The use of both hepatitis B surface antibody and core antibody in either setting followed by immunization was least economical, as costs were increased by 13% and 13.5% respectively. We concluded that hepatitis B core antibody should be used for screening in hospitals with high prevalence for hepatitis B virus antibodies among employees while hepatitis B surface antibody be used for screening in hospitals with low prevalence for hepatitis B virus antibodies among employees. A prediction of high and low prevalence for hepatitis B virus antibodies in hospital personnel may be made by knowledge of the distribution in ethnicity of staff.

Prevalence of serological hepatitis B markers in a working population in Hefei, China

Hepatitis B surface antigen and antibody (HBsAg and anti-HBs, respectively) prevalence was examined by means of solid-phase radioimmunoassay in 503 serum samples obtained from factory workers (230 men and 273 women) in Hefei, the capital city of Anhui Province, China, in 1985. The prevalence of HBsAg-positlve cases was 8% and that of anti-HBs-positive cases was 46%; the overall prevalence rate was 53% when the positivity in either of the two was considered to be indicative of hepatitis B virus (HBV) infection. There was no significant sex difference in the rate, whereas anti-HBs rate was slightly elevated in accordance with increased age. The review and evaluation of existing data in 14 articles led to a conclusion that the current HBV prevalence among Chinese populations will be in the range of 50% to 60%.

A hepatitis B vaccination program in a community teaching hospital

Prior to offering the hepatitis B (HB) vaccine, a prescreen for hepatitis B virus (HBV) antibodies was conducted in a 565 bed hospital in Pasadena, California. Antibodies to the hepatitis B virus were detected in 14.5% of 1,745 employees tested. There was a significantly higher prevalence in those with a previous history of hepatitis, blood transfusions, exposure to needlesticks, number of years in the same occupation, and in the same hospital work area. Employees of Asian extraction (33.3%) and blacks (23.1%) had a higher prevalence of antibodies to the hepatitis B virus than Hispanics (13.7%) and whites (10.2%). Anti-HBs was detected in 92.6% of 865 employees who received three doses of the hepatitis B vaccine. Only 28.6% of nonresponders receiving a fourth dose of hepatitis B vaccine produced anti-HBs. The nonresponders to the HB vaccine were older (average age 64.9 years) when compared to the responders (average age 37.5 years), and more males failed to produce anti-HBs after vaccination than females. Hepatitis B vaccination of the majority of individuals with either "low level" anti-HBs alone or anti-HBc alone did not elicit an anamnestic response after one dose of vaccine, implying that these "low level" antibodies are nonspecific and do not represent antiviral antibodies. Adverse reactions to the hepatitis B vaccine were minor and included a flu-like syndrome, sore arm, and rash and swelling at the injection site. The reasons for nonparticipation were obtained from 179 individuals, and the main issue was concern about safety of the hepatitis B vaccine.

Hepatitis B virus markers in male saudi blood donors

Hepatitis B surface antigen was determined by radioimmunoassay in 2487 male Saudi and 7587 Western expatriate volunteer blood donors. The HBsAg positivity rate was 8.5% in males Saudis and 0.7% in Western expatriate blood donors. This study was further extended to test other hepatitis B virus (HBV) markers and alanine aminotransferase (ALT) in 200 consecutive Saudi male blood donors' sera. A positivity rate for HBsAg was 8.5%, anti-Hbs was 35.5%, anti-HBc (alone) was 1.5%, HBeAg was 1.0%, and anti-HBe was 2.5%. A suggested nonspecific screening test for ALT enzymes with levels of ≥ 45 IU/L (normal 6-36 IU/L) for non-A, non-B hepatitis carrier state was performed on the 200 male Saudi blood donor sera, using Dupont ACA III methodology. The result showed an elevation of enzyme in 2.5% of Saudi donors. If a blood donor with any HBV marker were excluded the only 1.5% showed ALT enzyme elevation, considerably lower than the reported 3.6% in the U.S. blood donor population. The positivity rates of 8.5% for HBsAg, 35.5% for anti-HBs and 49% for any HBV serological markers in male Saudi blood donors are significantly higher than in American volunteer blood donors.

Hepatitis B virus in Gizan, Saudi Arabia

The enzyme-linked immunosorbent assay (ELISA) was used to study the prevalence rates for hepatitis B virus surface antigen (HBsAg), antibody to surface antigen (anti-HBs), and antibody to core antigen (anti-HBc) in 724 voluntary donors, students, pregnant women and those seeking treatment for minor ailments in the Gizan area of Saudi Arabia. Tests for hepatitis B e antigen (HBeAg) and e antibody (anti-HBe) were made in HBsAg positive sera. There was serological evidence of an existing or earlier infection in 337 Saudis (46.5%), of whom 12.7% were HBsAg carriers, 25.4% were positive for anti-HBs, and 8.4% were positive only for anti-HBc. The percentage of HBsAg carriers was 19.9% and 9.3% in males and females, respectively (p less than 0.001). The evidence of existing or earlier infection in males (58.7%) was significantly higher than in females (38.7%) (p less than 0.001), with no intersex difference in anti-HBs or anti-HBc. No difference was observed in the positivity of either of the markers, alone or together, between the cord blood and the female population in the child-bearing age of 20-39 years. Corresponding to the values in other age groups, there was an overall fall in the number of HBsAg carriers during adolescence as well as in 20-39-year-old females. Among the HBsAg carriers, there was no significant difference between the two sexes for HBeAg and anti-HBe positivity. The HBsAg carrier rate of 19.9% in males is consistent with the high male dominant prevalence of hepatocellular carcinoma in the Gizan area.(ABSTRACT TRUNCATED AT 250 WORDS)