title: Low adherence of HIV providers to practice guidelines for hepatocellular carcinoma screening in HIV/hepatitis B coinfection.
abstract: BACKGROUND
  In the era of combination therapy for human immunodeficiency virus (HIV), liver disease, and hepatocellular carcinoma (HCC) are major causes of death for patients coinfected with HIV and hepatitis B virus (HBV). This study compared HIV provider and hepatologist awareness of and adherence to the American Association for the Study of Liver Diseases (AASLD) practice guidelines for chronic HBV management. The primary endpoint of HIV provider adherence to HCC screening recommendations was compared to that of hepatologists at a large metropolitan academic medical center.
  
  
  METHODS
  Medical record database searches by ICD-9 codes were used to identify HIV/HBV coinfected (n = 144) and HBV monoinfected (n = 225) patients who were seen at least twice over a 2-year period in outpatient clinics. Adherence to AASLD guidelines was assessed by chart review. Provider awareness was evaluated through a voluntary anonymous survey with knowledge-based questions.
  
  
  RESULTS
  Over a 2-year period, only 36.0% of HIV/HBV coinfected patients seen in HIV practices completed HCC screening compared to 81.8% of HBV monoinfected patients in hepatology practices (P < .00001). Similarly, HIV providers less frequently monitored HBV viral load (P < .0001), HBeAg/anti-HBe (P < .00001), HBsAg/anti-HBs (P < .00001) than hepatologists but screened more often for hepatitis A immunity (P = .028). Self-reported adherence and knowledge scores were similar among 19 HIV providers and 16 hepatologists.
  
  
  CONCLUSIONS
  HIV providers ordered significantly fewer HCC screening and HBV monitoring tests than hepatologists within a single academic medical center. In the setting of increased reliance on quality indicators for care, both patients and providers will benefit from greater adherence to established guidelines.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Bevin
authors.initials: B
authors.lastname: Hearn
authors.affiliation: Department of Medicine, Division of Infectious Diseases.
authors.forename: Rachel
authors.initials: R
authors.lastname: Chasan
authors.affiliation: Department of Medicine, Division of Liver Diseases.
authors.forename: Kian
authors.initials: K
authors.lastname: Bichoupan
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Suprun
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: Department of Medicine, Division of Liver Diseases.
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Dieterich
authors.affiliation: Department of Medicine, Division of Liver Diseases.
authors.forename: Ponni
authors.initials: P
authors.lastname: Perumalswami
authors.affiliation: Department of Medicine, Division of Liver Diseases.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Branch
authors.affiliation: Department of Medicine, Division of Infectious Diseases.
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000821:virology*; D060085:Coinfection / Q000150:complications; D005260:Female; D005762:Gastroenterology; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006282:Health Personnel / Q000592:standards*; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D038801:International Classification of Diseases; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic
keywords: HIV/HBV coinfection; hepatitis B virus; hepatocellular carcinoma; management guidelines