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Chronic viral hepatitis B and C infection is three to five times more frequent than HIV in the USA, and chronically infected people are at risk for long-term sequelae including cirrhosis, liver decomposition, and hepatocellular carcinoma (Institute of Medicine, 2010). Socio-cultural factors are central to the way an individual constructs hepatitis B virus (HBV) infection, perceives it as serious health problem, and moves on to appropriate health behavior (Lee et al., J Canc Educ 25:337-342, 2010; Kim, J Health Care Poor Underserved 5:170-182, 2004; Lee et al., Asian Nurs Res 1:1-11, 2007; Wu et al, Asian Pac J Cancer Prev 8(1):127-234, 2007; Yang et al., J Korean Academy Nurs 40:662-675, 2010). The purpose of this study was to seek "real world" data about factors that influence the recognition and management of HBV infection in Korean Americans' socio-cultural contexts. The descriptive qualitative study used an interview informed by ethnography to collect data and was guided by the Network-Episode Model. (Pescosolido, Adv Med Sociol 2:161-184, 1991; Pescosolido, AJS 97:1096-1138, 1992; Pescosolido, Res Sociol Health Care 13A:171-197, 1996). The sample comprised 12 HBV patients and nine key informants. Six factors that influenced the management of HBV infection emerged from the interviews: recognition of disease within a social context, unrecognized disease in a hidden health system, the socio-cultural meaning of disease, lay construction of the cause of disease, misunderstandings and cultural learning styles, and personal and environmental barriers to health care. Each theme was associated with Korean American (KA) social contexts, participants' experiences, and the beliefs they held about the disease. The findings explored that the family network is "genetic code" for social networking among KAs and the network of patients was not geographically bound. Health management behaviors are mediated by an array of types and levels of social and personal networks, and this raises questions about current health education, management of HBV, and prevention of liver cancer.

SummaryBackgroundHepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.AimTo generate recommendations for the management of Asian Americans infected with HBV.MethodsThese guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from other recommendations in the treatment of both HBeAg positive and negative chronic hepatitis B (CHB), in the approach to HCC surveillance, and in the management of HBV in pregnant women.ResultsAsian American patients, HBeAg positive or negative, with HBV DNA levels >2000 IU/mL (>104 copies/mL) and ALT values above normal are candidates for anti‐viral therapy. HBeAg negative patients with HBV DNA >2000 IU/mL and normal ALT levels but who have either serum albumin <3.5 g/dL or platelet count <130 000 mm3, basal core promoter (BCP) mutations, or who have first‐degree relatives with HCC should be offered treatment. Patients with cirrhosis and detectable HBV DNA must receive life‐long anti‐viral therapy. Indications for treatment include pregnant women with high viraemia, coinfected patients, and those requiring immunosuppressive therapy. In HBsAg positive patients with risk factors, life‐long surveillance for HCC with alpha‐fetoprotein (AFP) testing and abdominal ultrasound examination at 6‐month intervals is required. In CHB patients receiving HCC treatments, repeat imaging with contrast CT scan or MRI at 3‐month intervals is strongly recommended. These guidelines have been assigned to a Class (reflecting benefit vs. risk) and a Level (assessing strength or certainty) of evidence.ConclusionsApplication of the recommendations made based on a review of the relevant literature and the opinion of a panel of Asian American physicians with expertise in HBV treatment will inform physicians and improve patient outcomes.

Background and Aims Telomere length has emerged as a promising risk predictor of various cancers including hepatocellular carcinoma (HCC). However, the majority of studies in this area measured telomere length in hepatocytes and one in lymphocytes with conflicting results. Moreover, no studies have been reported on using circulating DNA telomere length as a non-invasive HCC biomarker. Methods We conducted a nested case-control study to determine the relative telomere length (RTL) in serum DNA from 140 HBV-related HCC cases and 280 frequency-matched cancer-free HBV controls. Results Cases had a significantly longer RTL (median, 0.31; range, 0.02–2.31) than controls (median, 0.20; range, 0.01–1.60) (P=0.003). Consistently, longer RTLs conferred a significantly increased HCC risk compared to short RTLs in a univariate logistic regression analysis (odds ratio [OR]=1.55, 95% confidence interval [CI]=1.02–2.33, P=0.038). This association attenuated after multivariate adjustment (OR=1.40, 95% CI=0.90–2.19, P=0.132). In a quartile analysis, a significant dose-response relationship was noted in univariate analysis (Ptrend=0.017) which was again attenuated in multivariate analysis (Ptrend=0.079). Further analyses revealed that the significant association between serum RTL and HCC risk was evident in non-cirrhotic (OR=3.54, 95% CI 1.58–7.93 P=0.002), but not cirrhotic (OR=0.95, 95% CI 0.55–1.64, P=0.860) HBV patients. Moreover, the significantly increased HCC risk conferred by cirrhosis was modulated by RTL with a significant interaction effect (Pinteraction=0.013). Conclusions RTL in circulating cell-free serum DNA could potentially be used as a novel non-invasive biomarker for non-cirrhotic HCC. Prospective cohort studies are warranted to validate this finding and assess its clinical significance in HCC prevention.