W1812 Rheumatologists Awareness and General Practice in Screening for Hepatitis B Virus (HBV) Infection Prior to Initiating Immunomodulating Therapies

Chronic hepatitis B infection affects approximately 400 million people worldwide, with a disproportionately high prevalence in Asian Pacific Islanders (APIs). HCC is the second leading cause of cancer deaths among APIA men. It is estimated that one in ten APIs is chronically infected with HBV. The guidelines set forth by various organizations lack consistency with regard to HBV screening in APIs. Although screening of all APIs for chronic HBV has been advocated by multiple research groups and mandated by recent legislation in Congress, the Center for Disease Control and Prevention and AASLD each recommend slightly different guidelines. As part of the San Francisco Hep B Free campaign, we offered free serologic screening and vaccination, if appropriate, to over 2000 APIs between January and October 2008. Of the total number of participants screened (2,118), 72 (3.4%) were chronically infected. Of those people who reported previous vaccination, 90 (32.5%) lacked protective antibodies and 3 (1.1%) were actually chronically infected. Among the APIs screened, 64 (3.3%) were chronically infected with HBV. Of those not chronically infected, 993 (51%) lacked protective antibodies and were at risk for future infections. Men were 1.5 times as likely as women to be chronically infected. Adults aged sixty or older were three times more likely to be infected than people under the age of sixty. APIs born in endemic regions were 4.6 times more likely to be chronically infected than U.S.-born APIs. In an earlier study by Hutton et al., a Markov model of different screening strategies suggested that it is cost-effective to screen all APIs, irrespective of birthplace. To date, no studies have examined the rates of chronic infection in secondand third-generation APIs, i.e. U.S.-born APIs whose parents were born in Asia or the U.S. Based on an interim analysis of the San Francisco Hep B Free Campaign, we hypothesize that it is not cost-effective to screen all APIs given the lower prevalence rates in 2nd and 3rd generation U.S.-born APIs. We plan to integrate the data from our screening program with Hutton's model to re-evaluate costeffectiveness of HBV screening across different generations of APIs. Clearly, there is a need for identification of hepatitis B cases in the API community and vaccination when appropriate. By identifying non-traditional risk factors such as parental birthplace in U.S.-born APIs, we hope to make screening efforts more targeted, cost-effective, and successful.