All Publications

  • Chronic hepatitis B prevalence among foreign-born and US-born adults in the United States, 1999-2016. Hepatology (Baltimore, Md.) Le, M. H., Yeo, Y. H., Cheung, R., Henry, L., Lok, A. S., Nguyen, M. H. 2019


    Hepatitis B virus (HBV) infection remains a major global health problem, exacerbated by poor linkage to care. We aimed to determine the prevalence of HBV infection, exposure, self-reported vaccination, vaccine-induced immunity, disease awareness, and treatment in the United States (U.S.) by birthplace and race/ethnicity during 1999-2016. 47,628 adult participants in the National Health and Nutrition Examination Survey completed HBV core antibody (anti-HBc) and surface antigen (HBsAg) tests and 47,618 adults completed HBV surface antibody (anti-HBs) and anti-HBc tests and were included in the analysis. HBV infection was defined by positive HBsAg and past exposure by positive anti-HBc. Vaccine-mediated immunity was defined by positive anti-HBs and negative anti-HBc. No significant change in the prevalence of HBV infection was observed between 1999-2016 (P=0.442), affecting 0.35% (95% CI: 0.28-0.45) or 0.84 million adults. In contrast, a significant decrease in HBV exposure and increase in vaccine-mediated immunity was observed. U.S. born had significantly lower prevalence of HBV infection and exposure as well as higher prevalence of vaccine-mediated immunity and self-reported vaccination than foreign born. Prevalence of HBV infection was highest in non-Hispanic Asians in both foreign- (3.85%, 95% CI: 2.97-4.97) and U.S.-born (0.79%, 95% CI: 0.17-3.59) persons during 2011-2016. Among infected persons, liver disease awareness was only 15.19%, and treatment rate was only 4.60%. CONCLUSION: This study revealed disparities of HBV infection among ethnic/racial groups and between U.S.-born and foreign-born persons. Awareness of liver disease and treatment rate among infected persons was dismal. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/hep.30831

    View details for PubMedID 31228279

  • Prevalence of Undetectable Vaccine-Induced Immunity Against Hepatitis B Virus in US Adults at High Risk for Infection HEPATOLOGY Yeo, Y., Le, M. H., Chang, E. T., Henry, L., Nguyen, M. H. 2019; 69 (4): 1385–97

    View details for DOI 10.1002/hep.30285

    View details for Web of Science ID 000462612400006

  • Ethnic-Specific Prevalence of HBV Infection and Exposure in US-Born and Foreign-Born Persons in the United States from 2011-2016 Le, M., Yeo, Y., Nguyen, M. H. WILEY. 2018: 1212A–1213A
  • Initial Evaluation, Laboratory Monitoring, and Surveillance of Chronic Hepatitis B (CHB) Patients: Results of a Real-World Analysis of 85,922 Commercially-Insured Patients Tran, S., Jeong, D., Yeo, Y., Le, M., Henry, L., Cheung, R., Nguyen, M. H. WILEY. 2018: 82A
  • Sex, Time-Period and Birthplace Specific Prevalence of Hepatitis B and Hepatitis C Virus Infection in Children and Adolescents in the United States during 1999-2016 Zou, B., Yeo, Y., Le, M., Cheung, R., Nguyen, M. H. WILEY. 2018: 1193A
  • Prevalence of Hepatitis C Infection in Ethnically Diverse US Population Including Asian Americans and US-Born Vs Foreign-Born Persons: A Population-Base Study during 2011-2016 Zou, B., Le, M., Yeo, Y., Cheung, R., Nguyen, M. H. WILEY. 2018: 931A–932A
  • Prevalence of Hepatitis B Vaccination Coverage Versus Serologic Evidence of Hepatitis B Immunity in Children and Adolescents in the United States, 1999-2016 Le, M., Yeo, Y., So, S. K., Gane, E. J., Cheung, R., Nguyen, M. H. WILEY. 2018: 1192A–1193A
  • The Majority of Previously Uninfected High-Risk Adults in the United States Do Not Have Immunity Against Hepatitis B Virus: A Population-Based Study Yeo, Y., Le, M., Chang, E. T., Henry, L., Nguyen, M. H. WILEY. 2018: 134A–135A
  • High Prevalence of CKD and Associations between Fibrosis and Mortality in Patients with NAFLD Le, M., Yeo, Y., Tran, S., Nguyen, M. H. WILEY. 2018: 956A
  • Prevalence of NAFLD and Liver Fibrosis in Asian Americans: A Population Based US Study from Nhanes, 2011-2014 Le, M., Yeo, Y., Tran, S., Nguyen, M. H. WILEY. 2018: 1293A
  • The prevalence of undetectable vaccine-induced immunity against hepatitis B virus in US adults at high risk for infection. Hepatology (Baltimore, Md.) Yeo, Y. H., Le, M. H., Chang, E. T., Henry, L., Nguyen, M. H. 2018


    In 2015, the Centers for Disease Control and Prevention (CDC) reported a substantial increase in the number of acute hepatitis B virus (HBV) infections in the United States (US). Although national guidelines recommend vaccination of adults at high risk for HBV infection, the prevalence of undetectable immunity (i.e., susceptibility) in this population remains unknown. In this study, we analyzed a nationally representative sample using the National Health and Nutrition Examination Survey (NHANES) to evaluate the prevalence, trend, and predictors of undetectable vaccine-induced antibodies against HBV surface antigen (anti-HBs <10 mIU/mL) among high-risk adults from 2003-2014. Among adults at high risk for HBV infection, the prevalence of undetectable immunity decreased from 83.2% in 2003-2004 (95% confidence interval [CI]: 81.3-85.0) to 69.4% (about 64 million) in 2013-2014 (95% CI: 66.0-72.6). The prevalence decreased significantly in individuals with multiple sex partners or sexually transmitted disease and in pregnant women. However, there were no significant changes in men who have sex with men (MSMs), injection drug users (IDUs), hepatitis C virus (HCV)-infected and diabetes mellitus (DM)-patients, and those with elevated aspartate aminotransferase/ alanine aminotransferase (AST/ALT). Mexican Americans had the highest prevalence of undetectable immunity (77.6%, 95% CI: 72.6-81.9%), followed by non-Hispanic whites (70.1%, 95% CI: 66.9-73.1%). Older age, lower socioeconomic status, and having ≥1 high-risk factor(s) were associated with a higher risk of undetectable immunity, whereas an increased risk among the foreign-born disappeared after multivariable adjustment. In conclusion, around 64 million high-risk adults in the US remain susceptible to HBV infection, especially MSMs, IDUs, diabetics, HCV patients, and populations with elevated AST/ALT. To eliminate HBV, efforts should be made to increase screening and vaccination in high-risk adults. This article is protected by copyright. All rights reserved.

    View details for PubMedID 30246260

  • Factors Associated with Rates of HBsAg Seroclearance in Adults with Chronic HBV Infection: A systematic review and meta-analysis. Gastroenterology Yeo, Y. H., Ho, H. J., Yang, H. I., Tseng, T. C., Hosaka, T., Trinh, H. N., Kwak, M. S., Park, Y. M., Fung, J. Y., Buti, M., Rodriguez, M., Treeprasertsuk, S., Preda, C. M., Ungtrakul, T., Charatcharoenwitthaya, P., Li, X., Li, J., Zhang, J., Le, M. H., Wei, B., Zou, B., Le, A., Jeong, D., Chien, N., Kam, L., Lee, C. C., Riveiro-Barciela, M., Istratescu, D., Sriprayoon, T., Chong, Y., Tanwandee, T., Kobayashi, M., Suzuki, F., Yuen, M. F., Lee, H. S., Kao, J. H., Lok, A. S., Wu, C. Y., Nguyen, M. H. 2018


    Seroclearance of hepatitis B surface antigen (HBsAg) is a marker for clearance of chronic hepatitis B virus (HBV) infection but reported annual incidence rates of HBsAg seroclearance vary. We performed a systematic review and meta-analysis to provide more precise estimates of HBsAg seroclearance rates among subgroups and populations.We searched PubMed, Embase, and Cochrane library for cohort studies that reported HBsAg seroclearance in adults with chronic HBV infection with more than 1 year of follow up and at least 1 repeat test for HBsAg. Annual and 5-, 10-, and 15-year cumulative incidence rates were pooled using a random effects model.We analyzed 34 published studies (with 42,588 patients; 303,754 person-years of follow-up; and 3194 HBsAg seroclearance events), including additional and updated aggregated data from 19 studies. The pooled annual rate of HBsAg seroclearance was 1.02% (95% CI, 0.79-1.27). Cumulative incidence rates were 4.03% at 5 years (95% CI, 2.49-5.93), 8.16% at 10 years (95% CI, 5.24-11.72), and 17.99% at 15 years (95% CI, 6.18-23.24). There were no significant differences between sexes. A higher proportion of patients negative for HBeAg at baseline had seroclearance (1.33%; 95% CI, 0.76-2.05) than patients positive for HBeAg (0.40%; 95% CI, 0.25-0.59) (P<.01). HBsAg seroclearance was also associated with a lower baseline HBV DNA (6.61 log10IU/mL; 95% CI, 5.94-7.27) than in patients without HBsAg seroclearance (7.71 log10IU/mL; 95% CI, 7.41-8.02) (P<.01) and lower level of HBsAg at baseline (2.74 log10IU/mL; 95% CI, 1.88-3.60) than in patients without HBsAg seroclearance (3.90 log10IU/mL, 95% CI, 3.73-4.06) (P<.01). HBsAg seroclearance was not associated with HBV genotype or treatment history. Heterogeneity was substantial across the studies (I2=97.49%).In a systematic review and meta-analysis, we found a low rate of HBsAg seroclearance in untreated and treated patients (pooled annual rate approximately 1%). Seroclearance occurred mainly in patients with less active disease. Patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed.

    View details for PubMedID 30342034

  • Prevalence and predictors of hepatitis B immunization in adults without immunity for hepatitis B from 1999-2014: a population-based study of 27,713 adults in the US Le, M. H., Toy, M., Gane, E. J., So, S., Nguyen, M. H. WILEY. 2017: 1004A
  • Suboptimal rates, trends and predictors of hepatitis B vaccination in a population-based sample of children and adolescents in the United States (US) between 1999 and 2014 Le, M. H., Toy, M., Gane, E. J., So, S., Nguyen, M. H. WILEY. 2017: 1003A
  • Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States PLOS ONE Le, M. H., Devaki, P., Ha, N. B., Jun, D. W., Te, H. S., Cheung, R. C., Nguyen, M. H. 2017; 12 (3)


    In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 1988-1994. Our goal was to determine the NAFLD prevalence in the recent 1999-2012 NHANES, risk factors for advanced fibrosis (stage 3-4) and mortality. NAFLD was defined as having a United States Fatty Liver Index (USFLI) > 30 in the absence of heavy alcohol use and other known liver diseases. The probability of low/high risk of having advanced fibrosis was determined by the NAFLD Fibrosis Score (NFS). In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.93-5.08, p<0.001). In conclusion, in this most recent NHANES, NAFLD prevalence remains at 30% with 10.3% of these having advanced fibrosis. NAFLD per se was not a risk factor for increased mortality, but NAFLD with advanced fibrosis was. Mexican American ethnicity was a significant risk factor for NAFLD but not for advanced fibrosis or increased mortality.

    View details for DOI 10.1371/journal.pone.0173499

    View details for Web of Science ID 000399174300007

    View details for PubMedID 28346543

  • Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis. PloS one Vutien, P., Jin, M., Le, M. H., Nguyen, P., Trinh, S., Huang, J. F., Yu, M. L., Chuang, W. L., Nguyen, M. H. 2017; 12 (9): e0183851


    Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C.We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity.We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1-30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care.Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.

    View details for PubMedID 28877190

  • Poor adherence to hepatocellular carcinoma surveillance: a systematic review and meta-analysis of a complex issue. Liver international : official journal of the International Association for the Study of the Liver Zhao, C., Jin, M., Le, R. H., Le, M. H., Chen, V. L., Jin, M., Wong, G. L., Wong, V. W., Lim, Y. S., Chuang, W. L., Yu, M. L., Nguyen, M. H. 2017


    Hepatocellular carcinoma (HCC) surveillance is associated with improved outcomes and long-term survival. Our goal is to evaluate adherence rates to HCC surveillance.We performed a systematic search of the PubMed and Scopus databases and abstract search of relevant studies from recent major liver meetings. All searches and data extraction were performed independently by 2 authors. Analysis was via random-effects models and multivariate meta-regression.A total of 22 studies (n=19,511) met inclusion criteria (original non-interventional studies with defined cirrhosis or chronic hepatitis B or chronic hepatitis C with advanced fibrosis populations, and surveillance tests and intervals). Overall adherence rate was 52% (95% CI 38-66%). Adherence was significantly higher in cirrhotic patients compared to chronic hepatitis B and other high risk patients, in European compared to North American studies, in less than 12-month compared to yearly surveillance intervals, and in prospective compared to retrospective studies (71%, 95% CI 64-78% vs. 39%, 95% CI 26-51%, P<0.001). The between-study heterogeneity of all above analyses was significant (P<0.001). Only the study design (retrospective vs. prospective cohort) had statistical significance in a multivariate meta-regression model (P<0.05) and could account for some of the differences above.Overall adherence rate to HCC surveillance was suboptimal at 52% with no significant differences by liver disease etiology or study location in multivariate meta-regression analysis. Further research and educational efforts are needed to improve the current rate of HCC surveillance. This article is protected by copyright. All rights reserved.

    View details for PubMedID 28834146