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Updated: Jun 18, 2025
"Liver-on-a-Chip" Cultures of Primary Hepatocytes and Kupffer Cells for Hepatitis B Virus Infection
Published on: February 19, 2019
The challenges of integrating an immigrant population with chronic hepatitis B into long-term hepatology care:
Asli Akin Belli1, Fatima Omarufilo1, Jessie Birnbaum1
1Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medicine, Division of Hepatology, New York, USA.
Insights
Hepatitis B screening for West African immigrants faces challenges in linking individuals to long-term care. A significant portion of those with the Hepatitis B virus (HBV) carrier state show advanced fibrosis, underscoring the need for integrated care.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Hepatitis B virus (HBV) is endemic in West Africa, posing a significant public health challenge due to immigration to the United States.
- Screening programs identify HBV-infected individuals, but transitioning them to long-term care presents difficulties.
Purpose of the Study:
- To describe the challenges of integrating West African immigrants with HBV into long-term care.
- To assess the spectrum of disease severity in this population.
Main Methods:
- Screening of 749 individuals between 2019 and 2023, with serologic evaluation offered from 2022.
- Recording of diagnostic history, HBV care, serologic markers, AST/Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) scores, and transient elastography (TE).
Main Results:
- 75 individuals (10%) tested positive for Hepatitis B surface antigen (HBsAg), with 17 newly diagnosed.
- Only 37.8% of previously diagnosed individuals linked to long-term care.
- Among HBV treatment-naïve individuals, 66.1% were carriers, and 18.2% required therapy; 21.7% had advanced fibrosis (≥F2) on TE.
- No correlation found between APRI/FIB-4 scores and TE results.
Conclusions:
- Integrating individuals with HBV from West Africa into long-term care is challenging.
- Incorporating serologic evaluations into screening programs for immigrant communities is recommended.
- Up to 30% of individuals with an HBV carrier state may have advanced fibrosis (≥F2).
Objectives:
Hepatitis B virus (HBV) is endemic in West Africa. Because of immigration to the United States, screening and transition to long-term care is a significant public health concern. We describe the challenges of integrating individuals identified in a screening program into long-term care and the spectrum of disease severity.
Methods:
Between 2019 and 2023, 749 individuals were screened. Beginning 2022, all were offered a free serologic evaluation. Details of the previous diagnosis, HBV care, the serologic evaluation, aspartate aminotransferase to platelet ratio index, and Fibrosis index-4 scores were recorded. The results of transient elastography (TE) were correlated with the serologic evaluation.
Results:
A total of 75 (10%) individuals were hepatitis B surface antigen-positive, including 58 (77.3%) previously and 17 (22.7%) newly diagnosed. Despite attempts at linkage to care, only 14 (37.8%) of those diagnosed before the offer continued and/or entered long-term care. A total of 63 of 75 (84%) returned for the evaluation. Among 56 HBV treatment-naïve individuals, 66.1% had a serologic profile consistent with the carrier state. A total of 10 (18.2%) individuals met the criteria for HBV therapy, and 10 (21.7%) had ≥F2 fibrosis on TE. There was no correlation between aspartate aminotransferase to platelet ratio index and Fibrosis index-4 scores and TE. Eight (29.6%) of 27 patients with a profile of the HBV carrier state had ≥F2 fibrosis.
Conclusion:
Integration of individuals with HBV from West Africa identified in a screening program into long-term care is challenging. Inclusion of a serologic evaluation in programs for immigrant communities should be considered. Up to 30% of individuals with a serologic profile consistent with the HBV carrier state may have ≥F2 fibrosis.
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