Demographic and serological characteristics of Asian Americans with hepatitis B infection diagnosed at community screenings J. J. Xu, 1 C. Tien, 1 M. Chang, 1 J. Rhee, 1 A. Tien, 1 H. S. Bae, 1,2 F. C.-S. Ho, 2 L. S. Chan 3 and T.-L. Fong 1,3 1 Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA; 2 Private Practice, Los Angeles, CA, USA; and 3 Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Received October 2012; accepted for publication December 2012 SUMMARY. There is limited information regarding follow-up and hepatitis B serological status of Asian Americans diag- nosed with chronic hepatitis B (CHB) through community screening. The aims of this study were to evaluate the prevalence and characterize CHB among Asians living in Los Angeles, assess follow-up of individuals with CHB diag- nosed at screening and compare with patients with CHB followed by community gastroenterologists. Between Octo- ber 2007 and May 2010, 7387 Asians were tested for HBV. HBsAg positive individuals (CHB) underwent addi- tional testing for ALT, HBeAg/anti-HBe and HBV DNA. Patients with CHB were contacted 6 months later to deter- mine whether they received follow-up care. We compared serological patterns of these individuals with CHB to patients with CHB who were seen for the first time (treat- ment na € ıve) by community gastroenterologists during the study period. Prevalence of CHB was 5.2%. About 99% patients with CHB were foreign-born, and only 27% could read/write English. 297 (77%) patients with CHB could be reached 6 months after diagnosis; 43% did not receive fol- low-up care, mostly because of lack of medical insurance. Patients with CHB followed by gastroenterologists were more likely to have insurance (69% vs 26%, P < 0.0001). 90% patients with CHB at screening were HBeAg nega- tive/anti-HBe positive with 62% having inactive disease compared to only 30% of patients seen by gastroenterolo- gists (P < 0.0001). Among CHB participants, 13% met cri- teria for treatment compared to 51% of patients with CHB (P < 0.0001). Only a small number of CHB screening par- ticipants require antiviral therapy. Lack of medical insur- ance is the main reason for most patients with CHB not seeking follow-up care after screening. Keywords: disease surveillance, vaccination. INTRODUCTION The high prevalence of chronic hepatitis B infection (CHB) among Asian Americans has been reported in many stud- ies [1–4]. This is not surprising because more than 60% of Asian Americans are foreign-born [5]. Early diagnosis of CHB may result in initiation of medical management that includes monitoring of viral replication/disease activity, an- tiviral therapy when indicated and ongoing surveillance for hepatocellular carcinoma [3]. Patients who would ben- efit from treatment include patients with active disease manifested by elevated HBV DNA levels and aminotransfer- ase activities [6,7]. Suppression of HBV replication may reduce the risk of developing cirrhosis and hepatocellular carcinoma [8]. Despite many studies reporting results of HBV screening among Asian communities in the United States, there is little information regarding the HBV repli- cation status of those individuals with CHB nor their fol- low-up and outcomes after diagnosis with CHB at hepatitis B community screening events [1,2,9–13]. With over 2 million Asian Americans living within a 50 mile radius of Los Angeles [14], the Asian Pacific Liver Center (APLC) at Saint Vincent Medical Center in Los Angeles, California, a not-for-profit organization, was established to provide community outreach in the form of education and screening of hepatitis B. Medical care is also available to patients including to those without insurance at the APLC Clinic staffed by 2 hepatologists (H-SB and T-LF), a nurse practitioner (MC) and Korean- and Manda- rin-speaking personnel. We are reporting the prevalence of CHB among 7387 adults who participated in screenings Abbreviations: ALT, alanine aminotransferase; APLC, Asian Pacific Liver Center; CHB, chronic hepatitis B; CI, confidence interval; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; IOM, Insti- tute of Medicine; ULN, Upper limit of normal. Correspondence: Tse-Ling Fong, MD, Division of Gastrointestinal and Liver Diseases, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, 2/F, Los Angeles, CA 90033 USA. E-mail: tselingf@usc.edu © 2013 John Wiley & Sons Ltd Journal of Viral Hepatitis, 2013, 20, 575–581 doi:10.1111/jvh.12073