Is chronic hepatitis B being undertreated in the U.S.?

Chronic infection with the hepatitis B virus (HBV) is a major risk factor for development of end-stage liver disease and primary liver cancer. Despite the fact that there are between 1.4 and 2 million chronic HBV infections in the U.S., fewer than 50,000 people per year receive prescriptions for HBV medications. This presentation discusses possible explanations for this disparity. Data suggest that the largest gap remains in under-diagnosing HBV, with less than 40% of infected individuals aware of their infection. An additional barrier lies in access to care for infected individuals, with only approximately 15% of all infected individuals and less than 40% of diagnosed individuals entering into appropriate medical care for their HBV infection. Explanations for these gaps can include low screening and medical referral rates due to a number of physician and community-related barriers. This includes environmental barriers (lack of access) and individual barriers (low HBV knowledge, fear of stigmatization). Physician barriers include lack of knowledge about HBV and current screening/management guidelines. With only 10-15% of treatment-eligible individuals receiving HBV treatment, we discuss a true health inequity, especially for disproportionately affected populations, including Asian and Pacific Islanders (API). This disparity remains largely unexplored, and points to the need for further research to ensure that all high-risk individuals have equal access to HBV screening and care. Additionally, there is a vital need for effective methods of ensuring that chronically infected individuals receive regular monitoring of their infection and be treated if and when appropriate.