Abstract
Aims: Aim of this study was to analyze diagnostic and therapeutic trends of physicians regarding Chronic Hepatitis B (CHB) in Karachi since Pakistan is endemic area for viral hepatitis B.Methods: A questionnaire was distributed to about 100 physicians / doctors in different hospitals of Karachi. The questionnaire assessed diagnostic trends, prescribing habits for Chronic Hepatitis B (CHB) treatment and patients monitoring and follow ups by the physician.Results: About 100 doctors from Karachi participated in the study (response rate: 72%). 34.72% doctors had experience of treating less than 10 patients per month. Majority of the doctors (79.16%) used HBsAg (anti-HBsAg seroconversion), (61.11%) used liver function tests (LFTs) and hepatitis B virus (HBV) DNA levels were used by doctors (47.22%) as diagnostic parameters for CHB. HBV-DNA levels were the most commonly used parameter to confirm diagnosis and was used by 86.11 % doctors. Treatment of CHB was started upon various indications i.e. 58.33% doctors used HBV DNA level when it is e20,000 IU/mL (105 copies/mL) ; 36.11% used HBV DNA when it is e 2000 IU/mL (104 copies/mL) and 29.16% doctors used Serum alanine aminotransferase (ALT) when it was elevated for 3-6 months. Most of the doctors (38.88%) had experience with Interferon alfa and Pegylated IFN-a 2a, (26.38%) with Lamivudine and (25%) with Entecavir. For treatment, 41.66% of doctors recommended Pegylated IFN-a 2a for HBeAg positive CHB patients whereas 22.22% of doctors treated HBeAg negative CHB Patients with Entecavir. HBV DNA levels and alanine aminotransferase (ALT) levels were most commonly used to monitor therapy by 73.61% and 52.77% doctors respectively. Frequency of follow-up was after 3 months by most of the doctors (63.88%). According to 23.61% doctors, 5 to 10% of patients required add- on treatment or switching from the previous regimen. According to most doctors (68.05%), polymerase chain reaction (PCR) - negativity was an important indication of improved response and outcome to anti-viral therapy.Conclusion: CHB management decision varies from physicians perspective and is not always based on scientific decision. Mostly doctors used HBV DNA level as indication for treatment when it is e 2000 IU/mL (104 copies/mL) and prescribed Interferon alfa and Pegylated IFN-a 2a to their patients. Monitoring of therapy was usually done by observing HBV DNA levels and alanine aminotransferase (ALT) levels of patients and frequency of follow-up was after 3 months by most of the doctors. Add- on treatment or switching is also required by some patients and improved response to treatment was assessed by PCR negativity. Management of CHB can be improved through CME (continual medical education) and practical training.DOI: http://dx.doi.org/10.3329/jom.v14i1.14538 J MEDICINE 2013; 14 : 57-61
Highlights
Hepatitis B is a worldwide healthcare problem, especially in developing areas
Material and Methods The intent of this study is to examine the quality of care receive by CHB patients by assessing diagnostic and therapeutic trends of physicians regarding Chronic Hepatitis B in Karachi
A questionnaire was developed for the purpose of survey and is divided into four different sections: the first section includes questions related to the diagnosis of Chronic Hepatitis B and indications for treatment; the second section is designed to investigate about the treatment of Chronic Hepatitis B and drugs preferred in CHB patients; the third section focuses on monitoring and follow up of CHB patients; and the last section is about socioeconomic class of patients and frequency of contact of doctors to CHB patient and their treatment
Summary
Hepatitis B is a worldwide healthcare problem, especially in developing areas. An estimated one third of the global population has been infected with the hepatitis B virus (HBV). 350 million people are lifelong carriers, and only 2% spontaneously seroconvert annually. Ongoing vaccination programs appear to be promising in the attempt to decrease the prevalence of HBV disease. Antiviral treatment may be effective in approximately one third of the patients who receive it, and for selected candidates, liver transplantation currently seems to be the only viable treatment for the latest stages of hepatitis B. The hepatitis B virus (HBV) is transmitted hematogenously and sexually. The outcome of this infection is a complicated viral-host
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