From the Guidelines
Africans with hepatitis B (HBV) infection should start monitoring below the age of 40.
Rationale
- According to the evidence from 1, the AASLD Guideline recommends that African HBV carriers should start surveillance at age 20.
- This is because Africans with HBV seem to get hepatocellular carcinoma (HCC) at a younger age, as stated in 1.
- In contrast, South East Asians with HBV infection are recommended to start surveillance at age 40 for men and 50 for women, as mentioned in 1 and 1.
- The evidence suggests that the risk of HCC is higher in Africans with HBV infection at a younger age, making it necessary to start monitoring earlier.
- The recommended surveillance method is ultrasound (US) with or without alpha-fetoprotein (AFP) measurement, as stated in 1 and 1.
- The ideal surveillance interval is 6 months, as recommended by most guidelines, including 1 and 1.
From the Research
Hepatitis B Infection and Ethnicity
The question of which ethnicity, African or South East Asian, with hepatitis B (HBV) infection, should start monitoring below the age of 40, can be informed by several studies:
- A study from 2 found that Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected with HBV than those born in the United States.
- The same study 2 also found that 8.9% of Asian American adults screened were chronically infected with HBV, and 65.4% of the chronically infected adults were unaware that they were infected.
- Another study from 3 noted that chronic hepatitis B virus infection is a serious liver disease that disproportionately affects Asian and Pacific Islander immigrants.
- In contrast, a study from 4 found that African or Asian ethnicity is considered a risk factor for the development of hepatocellular carcinoma (HCC), but the study focused on people of African ancestry with HIV and Hepatitis B co-infection.
Monitoring Recommendations
Based on the available evidence:
- The study from 2 recommends that healthcare providers routinely screen Asian adults for HBV, regardless of their vaccination status.
- The study from 3 supports the expansion of HBV screening to non-pregnant adolescents and adults who were born in Asia and the Pacific Islands.
- However, there is limited evidence to suggest that Africans with HBV infection should start monitoring below the age of 40, although a study from 4 highlights the need for targeted surveillance in high-risk individuals, including those of African ancestry with HIV and HBV co-infection.
- It is worth noting that the studies from 5 and 6 provide context on the disparities in hepatitis B diagnosis, disease management, treatment, and prevention, but do not specifically address the question of monitoring below the age of 40.