Annals of Internal Medicine

Summaries for Patients

Screening for Hepatitis B Virus Infection: U.S. Preventive
Services Task Force Recommendation Statement

The full report is titled Screening

for Hepatitis B Virus Infection in
Nonpregnant Adolescents and
Adults: U.S. Preventive Services
Task Force Recommendation
Statement. It is in the 1 July
2014 issue of Annals of Internal
Medicine (volume 161, pages
58-66). The author is
M.L. LeFevre, on behalf of the
U.S. Preventive Services Task
Force.
This article was published online
first at www.annals.org on
27 May 2014.

Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations.
The USPSTF is a group of health experts that reviews published research and makes
recommendations about preventive health care. The USPSTF and its review of the
published research are supported by the Agency for Healthcare Research and Quality.
What is the problem and what is known about it so far?
Hepatitis B virus (HBV) infection spreads from person to person through contact
with infected body fluids. For example, the virus can be spread by sexual intercourse or
contaminated needles or from mother to baby at birth. Most people with HBV infection
recover in a few months, but some develop chronic inflammation (chronic HBV
infection), permanent scarring (cirrhosis) of the liver, or liver cancer.
An estimated 700,000 to 2.2 million people in the United States have chronic HBV
infection. People at high risk for HBV infection include those from regions in which 2 or
more of every 100 people have HBV infection. Currently, such regions include China,
sub-Saharan Africa, and Southeast Asia. People with HIV infection, injection drug users,
household contacts of people with HBV infection, and men who have sex with men are
also at high risk for HBV infection. Vaccination can prevent HBV infection, and an
increasing proportion of the U.S. population is vaccinated, including routine vaccination
of infants.
Screening for HBV infection with a blood test could identify people with chronic
infection who may benefit from earlier evaluation and management of the disease.
In 2004, the USPSTF recommended against screening the general population for
HBV infection because there was little evidence that screening improved patient
outcomes, infection rates were fairly low, and most people with infection do not develop
chronic infection. They also found limited evidence that treatment improved patient
outcomes. The USPSTF wanted to review studies published since that time to update this
recommendation.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published studies to identify the risks and benefits of screening for
HBV infection.
What did the authors find?
The USPSTF found that the screening test is accurate and current treatments improve
health outcomes. They judged that screening is of moderate net benefit in people at high
risk for infection.

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What does the USPSTF recommend that patients and doctors do?
Patients at high risk should be screened for HBV infection. High-risk persons include
those from regions with high rates of HBV infection, those who have HIV infection,
injection drug users, household contacts of people with HBV infection, and men who
have sex with men. Another important risk factor is lack of vaccination during infancy of
persons born in the United States to parents from a high-risk region.
What are the cautions related to these recommendations?
These recommendations apply only to screening nonpregnant adults who have no signs of
infection or liver disease.

I-28 2014 American College of Physicians

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