Management of chronic hepatitis B virus infection in remote-dwelling Aboriginals and Torres Strait Islanders: an update for primary healthcare providers.
Chronic HBV infection is common in remote Aboriginal and Torres Strait Islander communities, where resources are scarce and patients may have several concurrent illnesses. The management of chronic HBV infection has changed over recent years, with greater application of serological and radiological investigations and new, more acceptable treatments for chronic liver disease, cirrhosis and hepatocellular carcinoma. Optimal follow-up procedures for patients with chronic HBV infection are still being debated, but may not be applicable to Aboriginal and Torres Strait Islander communities where factors such as endemicity, remoteness, frequent comorbidities, shorter life expectancy and cultural differences in health priorities must be taken into consideration. We have defined an algorithm to assist primary care providers caring for patients with chronic HBV infection in Aboriginal and Torres Strait Islander communities. Patients are divided into one of three categories for follow-up and referral based on clinical features, and results of liver enzyme and serological tests.
Fisher
Dale A
DA
Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia. dale.fisher@nt.gov.au
Huffam
Sarah E
SE
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D063065:Organophosphonates; D011320:Primary Health Care / Q000379:methods*; D019035:Rural Health Services; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
D000998:Antiviral Agents; D016898:Interferon-alpha; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil