People at high risk for hepatitis B (HBV) should be screened for the virus, according to new recommendations from the U.S. Preventive Services Task Force (USPSTF).
The new document, by Michael LeFevre, MD, MSPH, on behalf of the USPSTF, is available in Annals of Internal Medicine. It updates the 2004 USPSTF recommendation that opposed HBV screening in asymptomatic people in the general population and contended the potential harm of screening outweighed benefits.
Newer evidence now indicates a moderate net benefit of screening for people at high risk of HBV infection, including:
- Persons who were born in the United States, were not vaccinated in infancy, and were born to parents from a country with a high HBV prevalence
- HIV-positive individuals
- Injection-drug users
- Household contacts of people with HBV
- Men who have sex with men.
Chronic HBV may progress to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Because those with chronic HBV can also transmit the virus, screening could identify individuals who might benefit from antiviral treatment or vaccination.
The updated recommendations focus on asymptomatic, nonpregnant adolescents and adults; LeFevre wrote that the task force would be updating its prenatal-screening guidance in the future.
In a different Annals of Internal Medicine report (2014;10:828-835), Ai Kubo, PhD, and colleagues described the combination of prenatal HBV screening and postnatal prophylaxis as “highly effective” in preventing mother-to-child transmission.
In related news, the Centers for Medicare & Medicaid Services (CMS) has announced that Medicare will cover hepatitis C virus (HCV) screening for adults when ordered by a beneficiary’s primary-care physician or practitioner and performed by an eligible Medicare provider.
- A screening test is covered for adults at high risk for HCV infection, defined as past or current users of illicit injection drugs and recipients of blood transfusions prior to 1992.
- Repeat screening for high-risk persons is covered annually only for those who have had continued illicit injection drug use since the prior negative screening test.
- A single screening test is covered for non-high-risk adults born from 1945 through 1965.