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The patient, the doctor, and the system: Underdiagnosis and undertreatment of hepatitis B

Chronic infection with the hepatitis B virus (HBV) is a major risk factor for the development of end-stage liver disease, including cirrhosis, liver failure, and primary liver cancer. There are now 7 antiviral agents approved by the US Food and Drug Administration for the management of chronic HBV infection. Despite the fact that there are between 1.4 and 2 million chronic HBV infections in the United States, fewer than 50,000 people per year receive prescriptions for HBV antiviral medications. This report discusses possible explanations for the disparity between the number of people who are chronically infected and the number of people who receive treatment. Explanations for this incongruence include the potentially large number of infected persons who are unscreened and thus remain undiagnosed, and lack of access, including insurance, education, and referral to appropriate medical care, particularly for disproportionately infected populations.