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Physicians should screen all asymptomatic but high-risk adolescents and adults for hepatitis B virus infection, according to an updated recommendation by the U.S. Preventive Services Task Force that was published online May 27 in Annals of Internal Medicine.
Since the last USPSTF recommendation on HBV screening in 2004, which focused on the general population and didn’t advocate screening of this subset of patients, research has documented that antiviral treatment improves both intermediate outcomes such as virologic and histologic responses and long-term outcomes such as prevention of hepatocellular carcinoma, cirrhosis, and end-stage liver disease.
Given this effectiveness, along with the 98% sensitivity and specificity of HBV screening tests, the group has now issued a level B recommendation that high-risk patients be screened, said Dr. Michael L. LeFevre, chair of the USPSTF and professor of family and community medicine at the University of Missouri, Columbia, and his associates.
High-risk patients include the following:
• People born in regions where the prevalence of HBV infection is 2% or greater, such as sub-Saharan Africa, central and southeast Asia, China, the Pacific Islands, and parts of Latin America. People born in these areas account for 47%-95% of the chronic HBV infection in the United States.
• American-born children of parents from these regions, who may not have been vaccinated in infancy.
• HIV-positive persons.
• IV-drug users.
• Household contacts of people with HBV infection.
• Men who have sex with men.
The updated USPSTF recommendations are in line with those of the Centers for Disease Control and Prevention, the American Association for the Study of Liver Diseases, the Institute of Medicine, and the American Academy of Family Physicians. The CDC additionally recommends HBV screening for blood, organ, or tissue donors; people with occupational or other exposure to infectious blood or body fluids; and patients receiving hemodialysis, cytotoxic therapy, or immunosuppressive therapy.
The USPSTF still does not recommend HBV screening for the general population. The prevalence of the infection is low in the U.S. general population, and most members of the general population who are infected with HBV do not develop the chronic form of the infection and do not develop complications like hepatocellular carcinoma or cirrhosis. The potential harms of general screening, then, probably exceed the potential benefits, Dr. LeFevre and his associates noted (Ann Intern. Med. 2014 May 27 [doi:10.7326/M14-1018]).
The USPSTF has separate recommendations regarding hepatitis B in pregnant women. These, along with the updated recommendations for high-risk patients, are available at www.uspreventiveservicestaskforce.org.
The USPSTF is a voluntary group funded by the Agency for Healthcare Research and Quality but otherwise independent of the federal government. Dr. LeFevre and his associates reported no potential financial conflicts of interest.
These "long overdue" recommendations are "a dramatic and welcome upgrade from the 2004 USPSTF guidelines, which issued a grade D recommendation against screening asymptomatic persons for HBV infection," said Dr. Ruma Rajbhandari and Dr. Raymond T. Chung.
"Many would argue that the USPSTF should have endorsed screening for HBV infection in high-risk populations a decade ago," they wrote. The group lagged far behind the American Association for the Study of Liver Diseases’ recommendations in 2001 and the CDC’s recommendations in 2005. "We may have thus missed an opportunity to screen many high-risk persons in the United States," Dr. Rajbhandari and Dr. Chung said.
The USPSTF update "would be more useful if they provided a clearer definition of the high-risk patient. ... We worry that busy generalist clinicians do not have the time to estimate their patients’ risks for HBV infection." Physicians may find it more helpful to look up the CDC’s table listing all the factors that render a patient high risk, they added.
Dr. Rajbhandari and Dr. Chung are with the liver center and gastrointestinal division at Massachusetts General Hospital, Boston. They reported no relevant conflicts of interest. These remarks were taken from their editorial accompanying Dr. Lefevre’s report (Ann. Intern. Med. 2014 May 27 [doi:10.7326/M14-1153]).
These "long overdue" recommendations are "a dramatic and welcome upgrade from the 2004 USPSTF guidelines, which issued a grade D recommendation against screening asymptomatic persons for HBV infection," said Dr. Ruma Rajbhandari and Dr. Raymond T. Chung.
"Many would argue that the USPSTF should have endorsed screening for HBV infection in high-risk populations a decade ago," they wrote. The group lagged far behind the American Association for the Study of Liver Diseases’ recommendations in 2001 and the CDC’s recommendations in 2005. "We may have thus missed an opportunity to screen many high-risk persons in the United States," Dr. Rajbhandari and Dr. Chung said.
The USPSTF update "would be more useful if they provided a clearer definition of the high-risk patient. ... We worry that busy generalist clinicians do not have the time to estimate their patients’ risks for HBV infection." Physicians may find it more helpful to look up the CDC’s table listing all the factors that render a patient high risk, they added.
Dr. Rajbhandari and Dr. Chung are with the liver center and gastrointestinal division at Massachusetts General Hospital, Boston. They reported no relevant conflicts of interest. These remarks were taken from their editorial accompanying Dr. Lefevre’s report (Ann. Intern. Med. 2014 May 27 [doi:10.7326/M14-1153]).
These "long overdue" recommendations are "a dramatic and welcome upgrade from the 2004 USPSTF guidelines, which issued a grade D recommendation against screening asymptomatic persons for HBV infection," said Dr. Ruma Rajbhandari and Dr. Raymond T. Chung.
"Many would argue that the USPSTF should have endorsed screening for HBV infection in high-risk populations a decade ago," they wrote. The group lagged far behind the American Association for the Study of Liver Diseases’ recommendations in 2001 and the CDC’s recommendations in 2005. "We may have thus missed an opportunity to screen many high-risk persons in the United States," Dr. Rajbhandari and Dr. Chung said.
The USPSTF update "would be more useful if they provided a clearer definition of the high-risk patient. ... We worry that busy generalist clinicians do not have the time to estimate their patients’ risks for HBV infection." Physicians may find it more helpful to look up the CDC’s table listing all the factors that render a patient high risk, they added.
Dr. Rajbhandari and Dr. Chung are with the liver center and gastrointestinal division at Massachusetts General Hospital, Boston. They reported no relevant conflicts of interest. These remarks were taken from their editorial accompanying Dr. Lefevre’s report (Ann. Intern. Med. 2014 May 27 [doi:10.7326/M14-1153]).
Physicians should screen all asymptomatic but high-risk adolescents and adults for hepatitis B virus infection, according to an updated recommendation by the U.S. Preventive Services Task Force that was published online May 27 in Annals of Internal Medicine.
Since the last USPSTF recommendation on HBV screening in 2004, which focused on the general population and didn’t advocate screening of this subset of patients, research has documented that antiviral treatment improves both intermediate outcomes such as virologic and histologic responses and long-term outcomes such as prevention of hepatocellular carcinoma, cirrhosis, and end-stage liver disease.
Given this effectiveness, along with the 98% sensitivity and specificity of HBV screening tests, the group has now issued a level B recommendation that high-risk patients be screened, said Dr. Michael L. LeFevre, chair of the USPSTF and professor of family and community medicine at the University of Missouri, Columbia, and his associates.
High-risk patients include the following:
• People born in regions where the prevalence of HBV infection is 2% or greater, such as sub-Saharan Africa, central and southeast Asia, China, the Pacific Islands, and parts of Latin America. People born in these areas account for 47%-95% of the chronic HBV infection in the United States.
• American-born children of parents from these regions, who may not have been vaccinated in infancy.
• HIV-positive persons.
• IV-drug users.
• Household contacts of people with HBV infection.
• Men who have sex with men.
The updated USPSTF recommendations are in line with those of the Centers for Disease Control and Prevention, the American Association for the Study of Liver Diseases, the Institute of Medicine, and the American Academy of Family Physicians. The CDC additionally recommends HBV screening for blood, organ, or tissue donors; people with occupational or other exposure to infectious blood or body fluids; and patients receiving hemodialysis, cytotoxic therapy, or immunosuppressive therapy.
The USPSTF still does not recommend HBV screening for the general population. The prevalence of the infection is low in the U.S. general population, and most members of the general population who are infected with HBV do not develop the chronic form of the infection and do not develop complications like hepatocellular carcinoma or cirrhosis. The potential harms of general screening, then, probably exceed the potential benefits, Dr. LeFevre and his associates noted (Ann Intern. Med. 2014 May 27 [doi:10.7326/M14-1018]).
The USPSTF has separate recommendations regarding hepatitis B in pregnant women. These, along with the updated recommendations for high-risk patients, are available at www.uspreventiveservicestaskforce.org.
The USPSTF is a voluntary group funded by the Agency for Healthcare Research and Quality but otherwise independent of the federal government. Dr. LeFevre and his associates reported no potential financial conflicts of interest.
Physicians should screen all asymptomatic but high-risk adolescents and adults for hepatitis B virus infection, according to an updated recommendation by the U.S. Preventive Services Task Force that was published online May 27 in Annals of Internal Medicine.
Since the last USPSTF recommendation on HBV screening in 2004, which focused on the general population and didn’t advocate screening of this subset of patients, research has documented that antiviral treatment improves both intermediate outcomes such as virologic and histologic responses and long-term outcomes such as prevention of hepatocellular carcinoma, cirrhosis, and end-stage liver disease.
Given this effectiveness, along with the 98% sensitivity and specificity of HBV screening tests, the group has now issued a level B recommendation that high-risk patients be screened, said Dr. Michael L. LeFevre, chair of the USPSTF and professor of family and community medicine at the University of Missouri, Columbia, and his associates.
High-risk patients include the following:
• People born in regions where the prevalence of HBV infection is 2% or greater, such as sub-Saharan Africa, central and southeast Asia, China, the Pacific Islands, and parts of Latin America. People born in these areas account for 47%-95% of the chronic HBV infection in the United States.
• American-born children of parents from these regions, who may not have been vaccinated in infancy.
• HIV-positive persons.
• IV-drug users.
• Household contacts of people with HBV infection.
• Men who have sex with men.
The updated USPSTF recommendations are in line with those of the Centers for Disease Control and Prevention, the American Association for the Study of Liver Diseases, the Institute of Medicine, and the American Academy of Family Physicians. The CDC additionally recommends HBV screening for blood, organ, or tissue donors; people with occupational or other exposure to infectious blood or body fluids; and patients receiving hemodialysis, cytotoxic therapy, or immunosuppressive therapy.
The USPSTF still does not recommend HBV screening for the general population. The prevalence of the infection is low in the U.S. general population, and most members of the general population who are infected with HBV do not develop the chronic form of the infection and do not develop complications like hepatocellular carcinoma or cirrhosis. The potential harms of general screening, then, probably exceed the potential benefits, Dr. LeFevre and his associates noted (Ann Intern. Med. 2014 May 27 [doi:10.7326/M14-1018]).
The USPSTF has separate recommendations regarding hepatitis B in pregnant women. These, along with the updated recommendations for high-risk patients, are available at www.uspreventiveservicestaskforce.org.
The USPSTF is a voluntary group funded by the Agency for Healthcare Research and Quality but otherwise independent of the federal government. Dr. LeFevre and his associates reported no potential financial conflicts of interest.
FROM ANNALS OF INTERNAL MEDICINE
Key clinical point: HBV screening is appropriate in all at-risk populations.
Major finding: Physicians should screen all adolescents and adults at high risk for HBV infection, including those born in regions where the virus is endemic, American-born children of such parents, household contacts of people with HBV, people with HIV, IV-drug users, and men who have sex with men.
Data source: A comprehensive review of the literature since 2004 regarding the benefits and harms of screening high-risk patients for HBV infection, and a compilation of recommendations for screening high-risk patients.
Disclosures: The USPSTF is a voluntary group funded by the Agency for Healthcare Research and Quality but otherwise independent of the federal government. Dr. LeFevre and his associates reported no potential financial conflicts of interest.
