Estimates for the number of people living with chronic hepatitis B virus (HBV) infection in the United States range from 700,000 to 2.2 million people. Those at highest risk of infection include individuals with HIV, injection drug users, men who have sex with men, and individuals who live in households with others infected with HBV.
In order to address who should be screened for HBV, the U.S. Preventive Services Task Force (USPSTF) recently issued recommendations, which were published in the Annals of Internal Medicine in May. The recommendations offer key guidance, since about 15% to 25% of people with chronic HBV eventually die of cirrhosis or hepatocellular carcinoma. “Screening for HBV infection could identify chronically infected persons who may benefit from treatment or other interventions, such as surveillance for hepatocellular carcinoma,” according to the USPSTF statement.
USPSTF found no randomized, controlled clinical trials that could prove a health benefit to screening asymptomatic adolescents and adults who are not pregnant, but it concluded that “screening is of moderate benefit for populations at high risk for HBV infection, given the accuracy of the screening test and the effectiveness of antiviral treatment,” according to the statement. Additionally, USPSTF found inadequate evidence of harm from HBV screening.
The task force also recommended treatment to prevent adverse health outcomes from chronic HBV infection. “The USPSTF found convincing evidence that antiviral treatment in patients with chronic HBV infection is effective at improving intermediate outcomes (that is, virologic or histologic improvement or clearance of hepatitis B e antigen) and adequate evidence that antiviral regimens improve health outcomes (such as reduced risk for hepatocellular carcinoma),” the statement said. “The evidence showed an association between improvement in intermediate outcomes after antiviral therapy and improvement in clinical outcomes, but outcomes were heterogeneous and the studies had methodological limitations.”
Read the complete USPSTF report, “Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults,” online.