American Association for Clinical Chemistry
Better health through laboratory medicine
January 2009 Clinical Laboratory News: Recommendations Revised for Chronic HBV Testing


January 2009: Volume 35, Number 1 

Recommendations Revised for Chronic HBV Testing

Based on a new look at epidemiologic data, CDC recently expanded its testing recommendations for chronic HBV infection, an effort to stem the rising incidence of the disease. A panel of researchers, physicians, and public health officials suggested the changes in light of data showing a high rate of HBV in certain populations.

Recent statistics show that the overall incidence of acute HBV has declined substantially since 1985, yet CDC estimates that 800,000 to 1.4 million Americans have HBV and that many are unaware of their disease.

While the rising incidence is not good news, drug therapy for the disease has improved. The advent of several effective antiviral drugs has made it possible to prevent or delay liver disease associated with HBV, underscoring the importance of identifying infected patients early in the disease process, when many are asymptomatic.

Serologic testing for hepatitis B surface antigen is the primary way to screen for HBV. Previous CDC guidelines called for testing pregnant women, infants born to HBsAg-positive mothers, household contacts and sex partners of HBV-infected persons, people born in countries with HBsAg prevalence ≥8%, individuals, like healthcare workers, exposed to blood or body fluids, and people infected with HIV. In the revised guidelines, CDC expanded the testing recommendations to include people born in countries with HBsAg prevalence ≥2%, people with behavioral exposures to HBV, including men who have sex with men and injection drug users, individuals receiving cytotoxic or immunosuppressive therapy, and those with liver disease of unknown etiology.

While the overall prevalence of HBV in the U.S. is an estimated 0.3% to 0.5%, up to 3% of men who have sex with men, 6% of injection drug users, and between 1% and 2.6% of those born in foreign countries are estimated to have HBV. The recommendations also for the first time give health professionals guidance for effective management of HBV patients.

The full report is available online.