Lin Steven Y, Chang Ellen T, So Samuel K
School of Medicine, Stanford University, CA, USA.
Asian Pac J Cancer Prev. 2009 Jul-Sep;10(3):383-6.
To assess and alleviate the burden of chronic hepatitis B virus (HBV) infection among low-income, uninsured Asian and Pacific Islanders (APIs) in San Jose, California.
From 2007 to 2008, we provided free HBV testing and follow-up to 510 patients, 74% of whom were foreign-born Vietnamese. Patients were tested for hepatitis B surface antigen and surface antibody. Chronically infected patients who elected to undergo follow-up monitoring were evaluated for liver damage (ALT), liver cancer (AFP), and HBV replication (HBV DNA).
Overall, 17% were chronically infected; 33% of these were unaware that they were infected. Of those who underwent follow-up monitoring, 100% had elevated ALT, 9% had elevated AFP, and 24% had HBV DNA levels that exceeded the threshold for treatment. Patients who were candidates for antiviral therapy were enrolled in drug assistance programs, and those with elevated AFP levels were referred for CT scans. Uninfected patients lacking protective antibodies were provided free HBV vaccinations.
More liver cancer prevention in the medically underserved API community is needed, including universal screening for HBV and follow-up for those chronically infected.
评估并减轻加利福尼亚州圣何塞市低收入、未参保的亚裔及太平洋岛民（API）中慢性乙型肝炎病毒（HBV）感染的负担。
2007年至2008年，我们为510名患者提供了免费的HBV检测及后续跟踪服务，其中74%为出生在国外的越南人。对患者进行了乙肝表面抗原和表面抗体检测。选择接受后续监测的慢性感染患者接受了肝损伤（ALT）、肝癌（AFP）及HBV复制（HBV DNA）评估。
总体而言，17%的患者为慢性感染；其中33%的患者不知道自己已被感染。在接受后续监测的患者中，100%的患者ALT升高，9%的患者AFP升高，24%的患者HBV DNA水平超过治疗阈值。符合抗病毒治疗条件的患者被纳入药物援助项目，AFP水平升高的患者被转诊进行CT扫描。未感染且缺乏保护性抗体的患者接种了免费的HBV疫苗。
在医疗服务不足的API社区，需要加强肝癌预防工作，包括对HBV进行普遍筛查以及对慢性感染者进行跟踪。
