The Concept and management of Hepatitis B Virus Infection: Difference between General Practitioners and Hepatologists

Paik, Jin Ju; Lee, Hyeon Jin; Lee, Young Ho; Lee, Ka Young; Park, Tae Jin

Abstract

BACKGROUND: Korea is one of the endemic areas of viral hepatitis B, and 6-8% of general population are hepatitis B virus carriers. Although there have been little reduction in morbidity and infectivity of viral hepatitis B owlng to newer vaccines and the effects of immunizations, there are some differences among physicians in managing hepatitis B virus infection, and guidelines have not been established. Therefore in this study, we investigated general practitioners' concept and the practical management of viral hepatitis B in comparison with the hepatologists'.
METHODS
Information was obtained through questionnaires sent to 67 hepatologists and 400 general practitioners(general internists, general surgeons, family physicians, general physicians, and public health center managers) in Pusan during the 5 months from April to August, 1997. Overall respondents were 142(116 General practitioners, 26 Hepatologists), and the response rate was 32.9%.
RESULTS
In general practitioners, the most commonly used serologic test for viral hepatitis was HBsAg/MBsAb(71.0%). 51.9% of subjects underwent anti-HBs test 3-5 months later after vaccination. The most common revaccination method for healthy non-responders of initial vaccination was 3 series of immunizations with the same vaccine of equal dosage (36.9% ). 65.7% of subjects were tested for LFT every 6 months for chronic carriers, and 41.5% of them were advised - interferon treatment for chronic active hepatitis patients only if the patients requested it. In comparison with general practitioners, hepatologists had a tendency to add anti-HCV test for the serologic evaluation of hepatitis(56.6% vs 26.2%), to limit age for vaccination(82.6% vs 54.1% ), and to delay prescribing hepatotonics until the AST and ALT levels increased up to 2 folds normal(53.8% vs 39.1%). 38.5% of hepatologists did not recommend giving booster injection of hepatitis.
CONCLUSIONS
Practioal guidelines is necessary to manage viral hepatitis B patients.