Hepatitis B screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

High-risk groups should be tested for HBV infection. These include immigrants/refugees from areas of intermediate or high endemicity, persons with chronically elevated aminotransferases, immunocompromised individuals, and persons with a history of injection drug use(IDU). Additionally, screening for hepatocellular carcinoma should extend to any HBV carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL.

Screening

Recommendations for Persons Who Should Be Screened for HBV Infection

The following groups should be tested for HBV infection:

• Persons born in high or intermediate endemic areas
• United States–born people who were not vaccinated as infants and whose parents were born in regions with high HBV endemicity
• Persons with chronically elevated aminotransferases
• Persons who require immunosuppressive therapy
• Men who have sex with men
• People with multiple sexual partners or history of sexually transmitted disease
• Incarcerated people
• Persons who have ever used injecting drugs, dialysis patients, HIV- or HCV-infected individuals, pregnant women, and family members, household members, and sexual contacts of HBV-infected people
• Testing for HBsAg and anti-HBs should be performed, and seronegative persons should be vaccinated. (Grade I Recommendation)

Group	Screening Recommendations
Pregnant women	All pregnant women should screen (HBsAg testing) at the first prenatal visit Re-screen women with unknown HBsAg status or new or continuing risk factors Refer women who test positive for counseling and medical management Administer hepatitis B vaccine and hepatitis B immune globulin to exposed infants within 12 hours of birth
Asymptomatic/Nonpregnant adolescents and adults at high risk (HBV)	Risk Assessment: Persons born in countries and regions with a high prevalence of HBV infection (≥2%) U.S.-born persons not vaccinated as infants whose parents were born in regions with a very high prevalence of HBV infection (≥8%), HIV-positive persons Injection drug users Men who have sex with men Household contacts or sexual partners of persons with HBV infection Screening Tests: (HBsAg) test followed by a licensed, neutralizing confirmatory test Testing for antibodies to HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc) (distinguish between infection and immunity)

Recommendations for HCC Screening: AASLD Practice Guidelines

The following groups should be screened with US examination every 6-12 months: (Grade II-2)

• HBV carriers at high risk for HCC such as Asian men over 40 years and Asian women over 50 years of age
• People with cirrhosis
• People with a family history of HCC
• Individuals of African descent over 20 years of age
• Any carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL

For HBV carriers at high risk for HCC who are living in areas where US is not readily available, periodic screening with AFP should be considered. (Grade II-2)