Screening in chronic hepatitis B carriers - A retrospective study in a primary care clinic

Abstract

Objective: To review the current hepatocellular carcinoma screening tests in hepatitis B virus (HBV) carriers in primary care, aiming at standardising and improving patient management, as well as increasing cost-effectiveness. Design: A retrospective non-interventional study of screening methods in HBV carriers. Subjects: Patients attending the Family Medicine Training Centre of Prince of Wales Hospital between 1 July 2003 and 3 October 2003 for the follow-up of hepatitis B. Main outcome measures: Follow up frequencies, intervention frequencies (AFP, ALT, USG livers), presence or absence of HCC/cirrhosis. Results: 282 patients were included in the study. The mean frequencies for interventions were: (1) follow up consultation: once every 7 months; (2) AFP: once every 12 months; (3) ALT. once every 11 months; (4) USG: once every 22 months. Five new occurrences of cirrhosis were detected by USG over a four-year period. No associated AFP/ALT changes were noted. The 14 cases with raised ALT and AFP had normal ultrasound findings. Cirrhosis was an important determinant in increasing intervention frequency. The sensitivity and specificity of detecting cirrhosis with AFP and ALT were both 0.08 and 0.97 respectively. Conclusion: Data from this analysis support the use of USG alone in monitoring HBV carriers in the primary care setting. Biochemical investigations play a minimal role. Further studies will help to establish the feasibility of screening by USG alone.