Epidemiology of Chronic Hepatitis B Infection in South Bronx Community Hospital

Abstract

Purpose: Prior study reported that prevalence of hepatocellular carcinoma (HCC) and portal hypertension from chronic hepatitis B virus (HBV) infection was 44% among Hispanics and 28% among Blacks. Since our institution predominantly serves these populations therefore we retrospectively studied the epidemiology of HBV infection in our community. Methods: We reviewed medical records all patients age ≥18 years with chronic HBV infection who had been evaluated at the clinics affiliated with Bronx Lebanon Hospital Center between January 1, 2002 and December 31, 2004. Results: 167 patients with chronic HBV infection were identified with mean age of 40 years (range 18–81). Of these, 82 (49%) patients were males. 103 (62%) were African-Americans, 60 (36%) Hispanics and 4 (2%) others. Majority of the patients were covered by health insurance (127, 76%). Co-morbidities included HIV (23, 14%), HCV (8, 5%), HIV and HCV (4, 2%). Of the 16 patients with liver cirrhosis, 9 (56%) were found to be decompensated and 1 (6%) had HCC. Among 68 patients who had HBeAg status known, 23 (34%) had positive HBeAg. Of 78 patients with alpha-fetoprotein (AFP) known, 69 (88%) had AFP level less than 10 ng/mL. Liver imaging study for HCC screening was performed in 80 (48%) patients. 12 (7%) patients underwent HBV treatment. Among 155 patients who were not treated, 107 (69%) had alanine aminotransferase (ALT) level less than upper limit of normal (ULN) without evidence of liver cirrhosis. 48 patients were not eligible for HBV treatment for the following reasons: 20 (42%) were active injection drug or heavy alcohol users, 17 (35%) were non-compliant with visits during the evaluation period and 11 (23%) did not have health insurance coverage. Conclusions: In the South Bronx, nearly half of our patients underwent HCC screening. More than half of patients with liver cirrhosis were decompensated. Most of our patients were not considered to be candidates for treatment because of normal ALT levels and potentially modifiable social factors. Recognition and management of the identified factors may increase rate of HCC screening and HBV treatment.