USPSTF reaffirms advice on HBV screening in high-risk individuals

Last Updated: 2020-12-15

By Megan Brooks

NEW YORK (Reuters Health) - The U.S. Preventive Services Task Force (USPSTF) continues to recommend screening for hepatitis B virus (HBV) in nonpregnant adolescents and adults at increased risk for HBV infection, concluding with "moderate certainty" that such screening has moderate net benefit.

This grade "B" recommendation is in line with the 2014 USPSTF recommendation on HBV screening and is "strengthened by new evidence from trials and cohort studies reporting that antiviral therapy reduces risk of mortality and hepatocellular carcinoma and improves intermediate outcomes that are consistently associated with better health outcomes," the task force said today in JAMA.

They recommend HBV screening be done using approved hepatitis B surface antigen (HBsAg) tests, followed by a confirmatory test for initially reactive results.

An estimated 862,000 people in the United States are living with chronic HBV infection and roughly two-thirds are unaware of their infection, with many having no symptoms until onset of cirrhosis or end-stage liver disease, the task force notes.

"Important" risk groups for HBV screening include people born in countries and regions with a high prevalence of HBV infection (at least 2%), such as Asia, Africa, the Pacific Islands, and parts of South America and people born in the U.S. who were not vaccinated as infants and whose parents were born in regions with a very high prevalence of HBV infection (at least 8%).

Other important risk groups include HIV-positive individuals, injection-drug users, men who have sex with men and household contacts or sexual partners of persons with HBV infection.

"It is vitally important that clinicians screen people who are at increased risk and ask their teen and adult patients about any personal circumstances and behaviors that may put them at increased risk for hepatitis B," task force member Dr. Chyke Doubeni told Reuters Health by email.

"By screening teens and adults who are at increased risk for hepatitis B, we have the chance to help prevent serious health problems from developing," he added.

The co-authors of a JAMA editorial say the latest task force recommendation on HBV screening includes a "comprehensive list of persons at increased risk of HBV infection, but several groups who are also at increased risk of infection or who could benefit from having their infection diagnosed should also be added to the list."

Dr. Jessica Hwang of the University of Texas MD Anderson Cancer Center, in Houston, and Dr. Anna Lok of the University of Michigan, in Ann Arbor, say these include people with chronic liver disease and those with cancer or other conditions requiring immunosuppressive therapy.

Screening in the latter group is "important to identify those who might benefit from prophylactic antiviral therapy to prevent HBV reactivation, which can be fatal in some cases," they point out.

Drs. Hwang and Lok think it "may soon be time to move to universal HBV screening for the general US population, particularly if new therapies in development are found to be more effective in achieving sustained clearance of HBsAg, an indicator of functional HBV cure."

The updated recommendation on hepatitis B screening in nonpregnant adolescents and adults is available on the USPSTF web site at: www.uspreventiveservicestaskforce.org. The task force already recommends that all pregnant women be screened for HBV at their first prenatal visit.

SOURCE: https://bit.ly/386jpZd https://bit.ly/2IPxSA3 https://bit.ly/3oVj8Pz and https://bit.ly/3ae2TJq JAMA, online December 15, 2020.