Am Fam Physician. 2015 Mar 1;91(5):279.
Original article: Challenges and Opportunities in the Care of Asian American Patients
Issue date: October 1, 2014
Available online at: http://www.aafp.org/afp/2014/1001/p490.html
to the editor: With regard to the case scenario posed in this article, I would like to comment as a family physician with an interest in the care of patients with hepatitis B. Although we should be circumspect about using scare tactics with our patients, I believe that one should emphasize the need for surveillance for cirrhosis and hepatoma in a 48-year-old male immigrant with chronic hepatitis B. To this end, I believe it is fair to emphasize the word cancer—a diagnosis fraught with fear and foreboding regardless of one's ethnicity or cultural identity.
Although the patient in the case scenario may not need antiviral treatment now, he should be informed that if future testing reveals that the hepatitis B has begun to cause hepatocellular damage, oral antiviral treatment is available, and that such treatment will decrease the likelihood of progression to cirrhosis and hepatoma.
As an aside, complete blood counts are justified to evaluate liver health. I have found that many such complete blood counts reveal eosinophilia. The main parasite for which to search in such cases is Strongyloides stercoralis, which can persist in immigrants because of its multiorgan life cycle. In many immigrants from Asia whom I have evaluated for hepatitis B, I have diagnosed Strongyloides infection via immunoglobulin G by enzyme-linked immunosorbent assay—easily treated with ivermectin. As Dr. Nguyen notes, many screening tests and preventive services can be completed with a simple blood draw, as in the case of Strongyloides, for which serologic testing is better than stool sampling.
Author disclosure: Dr. Yamada has served on an advisory board for Gilead.
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