New hepatitis B screening recommendations announced by the U.S. Preventive Services Task Force

According to the Centers for Disease Control and Prevention, about 1.2 million people in the United States have hepatitis B, or HBV. And most of them are unaware that they even have the infection.

“Only 32% of individuals chronically infected with HBV in the U.S. are aware of their infection,” says Anna Lok, M.D., assistant dean for clinical research and director of clinical hepatology at Michigan Medicine. “Even with access to safe and effective vaccines, the prevalence of HBV in young adults throughout the country is on the rise. This could be due to several things, including low immunity rates among adults and the ongoing opioid epidemic.”

According to Lok, to meet the World Health Organization’s goal of eliminating viral hepatitis by 2030, effective strategies are needed to improve both vaccination and diagnosis rates, as well as “linkages to care and treatment plans” when necessary. Lok is also a co-author on the American Association for the Study of Liver Diseases Task Force on Elimination of Viral Hepatitis.

The benefits of improving diagnoses for individuals with HBV are vast, as antiviral treatments have been proven to reduce the risks of cirrhosis, liver cancer and liver-related mortality.

“By improving the diagnosis of HBV infection among individuals, society benefits, as well,” says Lok. “This happens when people who are infected receive treatments that lower their risk of transmitting the virus. It also alerts their sexual and household contacts regarding the need to be vaccinated.”

However, several challenges around diagnosing HBV continue to exist, including the fact that most individuals with the condition remain asymptomatic. This, in turn, means that improving detection rates relies heavily upon improving screening methods for asymptomatic people with the disease.

Lok commented on the U.S. Preventive Services Task Force, or USPSTF, updated guidelines for HBV screening. Her editorial was recently published in JAMA.

“The new recommendations reinforce and strengthen the 2014 guidelines, citing additional data that show the clinical benefits of antiviral therapy in decreasing mortality rates, as well as the risk of developing liver cancer,” says Lok.

Lok notes that the new recommendations also affirm the reliability of serologic tests for detecting hepatitis B surface antigen (HBsAg) when screening for HBV infections, and the lack of evidence of harm associated with screening.  

“The guidelines rendered a ‘grade B’ recommendation, which ensures that insurance companies will continue to cover HBV screenings without a required copay, for persons at increased risk of HBV,” says Lok.

The groups for which the USPSTF recommends HBV screening includes:

• Individuals born in a country where the HBV prevalence is 2% or greater;
• Individuals born in the U.S. who have not received the HBV vaccine and have parents from a country where the HBV prevalence is 8% or higher;
• Individuals who identify as household contacts and/or sexual partners of persons with chronic HBV infection;
• Individuals who have used injected drugs and/or drug-related needles in the past or present;
• Men who have sexual relations with other men; and
• Individuals with HIV.

“In clinical practice, determining whether a patient belongs to one of these high-risk groups can be challenging. And this list of risk factors is too complicated to implement as alerts in the electronic medical record system,” says Lok. “An effective identification process for persons with HBV will require simple strategies such as hepatitis C screening. The USPSTF previously recommended screening all adults born between 1945 and 1965, and more recently, updated their recommendations to all adults aged 18 to 79 years.”

Lok adds that expanding the scope of HCV screening was prompted by the availability of direct-acting antiviral drugs that can cure more than 95% of patients with hepatitis C.  In addition, current treatments for HBV are highly effective in suppressing the virus and in reducing the risks of cirrhosis and liver cancer. But they are not curative.

“If the new drugs in development are shown to cure HBV, universal screening may be appropriate.”