blood test in a syringe

Hepatitis B Research and Immigrant and Refugee Communities

By Margaret Shuhart, MD, MS Director, Hepatitis and Liver Clinic, Harborview Medical Center

Hepatitis B research traditionally has been underfunded, as diseases such as HIV and hepatitis Chave been given higher priority by funding agencies. More recently, the NIH has established the Hepatitis B Research Network (HBRN), a group of 28 clinical sites across the US and Canada designed to address important clinical questions pertaining to hepatitis B in both children (7 sites)and adults (21 sites). Seattle has both adult and pediatric sites. Broad questions being asked by the HBRN include why some develop severe liver disease and liver cancer while others have inactive disease, how to improve the response to current treatments, and whether indefinite treatment is really required in those who have e antigen-negative disease.

Most Southeast Asian/Asian adult persons have e antigen-negative hepatitis B, and many of these have active disease that places them at risk for cirrhosis and liver cancer. Despite the well-known benefits and excellent safety records of hepatitis B oral treatments, those with active disease are often reluctant to be treated, particularly if it is expected that such treatment will be lifelong. Identifying those for whom shorter duration treatment may be successful is critical if we are to engage morein treatments that can prevent the development of significant liver disease and liver cancer.

African-born individuals also have a high prevalence of hepatitis B infection. Through the HBRN studies, which to date have enrolled nearly 175 people from East and West Africa, we are able to explore risk factors for disease in these less frequently studied populations and include them in ongoing treatment trials. African Americans enrolled in our study, whether African or US-born,recently were found to be at increased risk for diabetes. Diabetes is known to further increase the risk for liver disease and liver cancer in people with chronic liver disease.

Additional HBRN studies in progress include the effects of hepatitis B on quality of life (in both children and adults), maternal knowledge of children’s hepatitis B infection and vaccination status,the impacts of alcohol and tobacco use on liver disease, the impact of pregnancy on hepatitis B activity, the role of the immune system in hepatitis B disease, and several others.

For more information about research studies, see:

  • Hepatitis B Research Network (this site includes related links to CDC, clinical, American Liver Foundation, Immunization Action Coalition, among others)
  • Registered Clinical Trials (nationwide)
  • Research contacts for local HBRN studies:
    Alycia Wolfstone RN, 206-744-7053, and Dr. Margaret Shuhart, 206-744-7054,

Photo by Marco Verch (cc license).