The Insidious Killer: Chronic Hepatitis B Virus Disease Management and Cultural Considerations for the Asian American and Pacific Islander Population in Primary Care

Jenny Chin *

California State University, Los Angeles - Patricia A. Chin School of Nursing, USA.

Stefanie Varela

California State University, Los Angeles - Patricia A. Chin School of Nursing, USA.

*Author to whom correspondence should be addressed.


Chronic hepatitis B (CHB) is a significant health concern in the Asian American and Pacific Islander (AAPI) community. The lack of initial symptoms underscores the importance of early detection because it may impact the individual’s quality of life and poses a risk for transmission impact in public health. The challenges in management in primary care setting for the AAPI community are multifaceted. The challenges include stigma related to cultural beliefs, lack of knowledge, and language barriers. Understanding stigma while incorporating universal screening protocols is crucial for primary care providers to utilize for early detection, reducing transmission, and lowering the risk of hepatocellular cancer (HCC).


Objective: Understanding the approach and clinician review of CHB. Discuss the challenges of treating CHB in the AAPI community. Describe universal screening protocol per CDC, identify destigmatizing approaches, and use cultural considerations to expand screening and treatment within the AAPI community. Identify evidence-based approaches from guidelines from AASLD.

Keywords: Hepatitis b virus, chronic hepatitis B, asian american and pacific islander, cultural considerations, stigma, primary care provider, nurse practitioner

How to Cite

Chin , Jenny, and Stefanie Varela. 2024. “The Insidious Killer: Chronic Hepatitis B Virus Disease Management and Cultural Considerations for the Asian American and Pacific Islander Population in Primary Care”. Asian Journal of Medical Principles and Clinical Practice 7 (2):306-15.


Download data is not yet available.


Center for Disease Control and Prevention. What is hepatitis B - FAQ. Centers for Disease Control and Prevention; 2021.

Accessed December 7, 2023.

Hyun S, Ko O, Kim S, Ventura WR. Sociocultural barriers to hepatitis B health literacy in an immigrant population: A focus group study in Korean Americans. BMC Public Health. 2021;21 (1):456. DOI:10.1186/s12889-021-10441-4

Ma GX, Zhu L, Tan Y, et al. A comparative trial of improving care for underserved Asian Americans infected with hepatitis B virus. Dig Dis Sci. 2023;68 (6):2333-2343. DOI: 10.1007/s10620-023-07840-5

Li AA, Kim D, Kim W, et al. Disparities in mortality for chronic liver disease among Asian subpopulations in the United States from 2007 to 2016. J Viral Hepat. 2018; 25(12):1608-1616. DOI: 10.1111/jvh.12981

World Health Organization. Hepatitis B. World Health Organization; 2023.

Accessed December 18, 2023.

Razavi-Shearer D, Gamkrelidze I, Pan CQ, et al. The impact of immigration on hepatitis B burden in the United States: A modeling study. Lancet Reg Health Am. 2023;22:100516. DOI: 10.1016/j.lana.2023.100516

Hollier A. Clinical Guidelines in Primary Care. Advanced Practice Education Associates; 2021.

Mokaya J, McNaughton AL, Burbridge L, et al. A blind spot? confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res. 2018;3:29. DOI: 10.12688/wellcomeopenres.14273.2

Freeland C, Farrell S, Kumar P, et al. Common concerns, barriers to care, and the lived experience of individuals with hepatitis B: A qualitative study. BMC Public Health. 2021;21(1): 1234. DOI: 10.1186/s12889-021-11093-0

Lok AS. Hepatitis B virus: Overview of management. UpToDate; 2021.

Accessed November 30, 2023.

Nguyen MH, Wong G, Gane E, Kao JH, Dusheiko G. Hepatitis B virus: Advances in prevention, diagnosis, and therapy. Clin Microbiol Rev. 2020;33(2): e00046-19. DOI: 10.1128/cmr.00046-19

Bickley LS, Szilagyi PG, Hoffman RM. Bates’ Guide to Physical Examination and History Taking. 13th ed. Philadelphia: Wolters Kluwer; 2021.

Wei L, Ploss A. Mechanism of hepatitis B virus cccDNA formation. Viruses. 2021;13 (8):1463. DOI: 10.3390/v13081463

Hong M, Bertoletti A. Tolerance and immunity to pathogens in early life: Insights from HBV infection. Semin Immunopathol. 2017;39(6):643-652. DOI: 10.1007/s00281-017-0641-1

Tripathi N, Mousa OY. Hepatitis B. National Library of Medicine; 2023. Available:

Tong MJ, Pan CQ, Han SHB, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47(8):1181-1200. DOI: 10.1111/apt.14577

Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. DOI: 10.1002/hep.29800

Colombo M, Sirlin CB. Surveillance for hepatocellular carcinoma in adults. UpToDate; 2022. Available:

Accessed on: December 1 2023.,

Smith-Palmer J, Cerri K, Sbarigia U, et al. Impact of stigma on people living with chronic hepatitis B. Patient Relat Outcome Meas. 2020;11:95-107. DOI: 10.2147/PROM.S226936

Zibrik L, Huang A, Wong V, et al. Let’s talk about B: Barriers to hepatitis B screening and vaccination among Asian and South Asian immigrants in British Columbia. J Racial Ethn Health.

Funchess TT, Fastring D, Walker V, et al. Hepatitis B screening, vaccination, and linkage to care: Lessons learned from a Mississippi Vietnamese community. Prog Community Health Partnership. 2022;16 (1):73-83. DOI: 10.1353/cpr.2022.0007