Both chronic hepatitis B and hepatitis C are prevalent among the 12 million Asians and Pacific Islanders living in the United States. Significant epidemiological and clinical differences exist between Asian Americans and the general U.S. population, most notably the higher rate of primary liver cancer and the differential response to various antiviral therapies. Perinatal and childhood transmission is common for hepatitis B virus. Transmission of hepatitis C virus probably also occurs early in life and results from nosocomial transmission and person-to-person spread. Asian patients with chronic hepatitis B commonly have hepatitis B e antigen-negative hepatitis B with either the precore or core-promoter mutant hepatitis B virus, which may require long-term antiviral viral therapy because of high rates of relapse following therapy. Asian patients with chronic hepatitis C may have a substantially higher risk of liver cancer but a better response to interferon-based therapy, both in terms of sustained virological response and reduced future incidence of liver cancer. Understanding these differences will lead to improved care for Asian Americans with viral hepatitis and better disease control for hepatitis B and hepatitis C for the entire U.S. population. This review briefly summarizes the major issues in the clinical care of patients with chronic viral hepatitis and focuses on pertinent epidemiological and clinical differences between Asian-American and Caucasian patients.
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