Stopping a Silent Killer in the Underserved Asian and Pacific Islander Community: A Chronic Hepatitis B and Liver Cancer Prevention Clinic by Medical Students

Objectives: To assess and alleviate the burden of chronic hepatitis B virus (HBV) infection among lowincome,uninsured Asian and Pacific Islanders (APIs) in San Jose, California.
Methods: From 2007 to 2008, weprovided free HBV testing and follow-up to 510 patients, 74% of whom were foreign-born Vietnamese. Patientswere tested for hepatitis B surface antigen and surface antibody. Chronically infected patients who elected toundergo follow-up monitoring were evaluated for liver damage (ALT), liver cancer (AFP), and HBV replication(HBV DNA).
Results: Overall, 17% were chronically infected; 33% of these were unaware that they wereinfected. Of those who underwent follow-up monitoring, 100% had elevated ALT, 9% had elevated AFP, and24% had HBV DNA levels that exceeded the threshold for treatment. Patients who were candidates for antiviraltherapy were enrolled in drug assistance programs, and those with elevated AFP levels were referred for CTscans. Uninfected patients lacking protective antibodies were provided free HBV vaccinations.
Conclusions:More liver cancer prevention in the medically underserved API community is needed, including universalscreening for HBV and follow-up for those chronically infected.