The U.S. Preventive Services Task Force (USPSTF) recommends hepatitis B virus (HBV) screening for nonpregnant high-risk adolescents and adults, according to a recommendation statement being published in Annals of Internal Medicine.
Up to 2.2 million people in the United States have chronic HBV, and 15 to 25 percent of those infected will die from liver disease or liver cancer. Screening for HBV could identify those who may benefit from treatment. Most people born in the United States have been vaccinated for HBV, which is the most effective way to prevent infection. However, there are some characteristics that put people at high risk. Those at high risk for HBV infection include persons born in countries with a high prevalence of HBV infection; U.S. citizens not vaccinated in infancy and whose parents are from a high-risk country; HIV-positive persons; injection drug users; those who have household contact with someone infected with HBV; and men who have sex with men.
Researchers conducted a systematic review of published evidence to assess the benefits and harms of screening high-risk individuals for HBV. They conclude with moderate certainty that screening for HBV infection in high-risk individuals has moderate net benefit. The recommendation applies to asymptomatic, nonpregnant adolescents and adults who have not been vaccinated and other persons at high risk. This is an update to a 2004 recommendation. Previously, the USPSTF focused its recommendation on only the general population.
The authors of an accompanying editorial express strong support for the new recommendations, but suggest that the guidelines should provide a clearer definition of “high-risk” to help busy clinicians apply these recommendations more easily in practice.
American College of Physicians