Recommended Groups for Routine HBV Screening
The Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Association for the Study of Liver Diseases (AASLD), and the American College of Physicians (ACP) all recommend performing routine screening for hepatitis B virus (HBV) infection in persons at increased risk of acquiring HBV infection.[1,2,3,4] The USPSTF recommendation was issued in 2014 as a grade B recommendation, meaning clinicians should offer or provide this service in practice.[2] The following list summarizes the groups considered to be high risk for HBV infection, in whom screening is recommended by the CDC. Certain indications for screening depend on country level HBV prevalence (Table 1).[3]
- Persons born in countries with a 2% or higher chronic HBV prevalence (defined as chronic infection and positive hepatitis B surface antigen [HBsAg])
- Persons born in the United States who were not vaccinated against HBV as an infant and whose parents were born in regions with high HBV endemicity (defined as an HBsAg prevalence of 8% or greater)
- Men who have sex with men
- Persons who inject drugs
- Persons with HIV infection
- Household and sexual contacts of persons with HBV infection
- Persons needing immunosuppressive therapy, including chemotherapy, immunosuppression related to organ transplantation, and immunosuppression for rheumatologic or gastroenterologic disorders
- Persons with end-stage renal disease, including persons receiving hemodialysis
- Donors of blood, plasma, organs, tissues, or semen
- Persons with elevated alanine aminotransferase levels of unknown etiology
- Pregnant women
- Infants born to mothers with HBV infection (HBsAg and anti-HBs only are recommended)
- Persons who are the sources of blood or body fluids resulting in an exposure (e.g. needlestick, sexual assault) that might require postexposure prophylaxis
- Unvaccinated persons traveling to countries with a chronic HBV infection prevalence of 2% or greater
Rationale for Routine HBV Screening of At-Risk Persons
There are multiple reasons why routinely screening for HBV infection in persons at increased risk of acquiring HBV infection. First, persons identified with chronic HBV can undergo evaluation for potential antiviral treatment; multiple safe and effective antiviral options are now available for persons who have an indication for treatment.[4,5] Second, since chronic HBV infection can lead to cirrhosis and complications of cirrhosis, persons identified with chronic HBV infection can have an evaluation for cirrhosis; if the individual has cirrhosis, they can receive further evaluation, management, and prevention of cirrhosis-related complications.[4,5,6] Third, persons with chronic HBV can be evaluated to see if they have an indication for hepatocellular carcinoma surveillance; if indicated, regular surveillance for hepatocellular carcinoma can identify early stage cancer lesions in the liver that have potential for cure.[7] Fourth, persons diagnosed with chronic HBV can receive hepatitis A immunization (if nonimmune) and receive counseling on how to minimize damage, such as avoiding excess alcohol intake or excessive acetaminophen ingestion.[3] Last, but not least, identifying persons with chronic HBV can reduce the population spread of HBV through treatment of HBV and appropriate prevention measures, such as counseling for preventing HBV transmission to others.[4]