Published: Feb 10, 2014
By Michael Smith, North American Correspondent, MedPage Today
People at high risk for hepatitis B (HBV) should be screened for the viral infection, according to a draft recommendation from the U.S. Preventive Services Task Force.
If approved, the recommendation would apply mainly to people born in countries where the prevalence of the disease is greater than 2%, the task force said.
But it would also apply to people born in the U.S. but not vaccinated as infants and whose parents come from regions with a high prevalence of HBV infection.
People living with HIV, injection drug users, and men who have sex with men would also be considered as being at high risk for HBV infection, as would patients with a weakened immune system or undergoing treatment for kidney failure.
The draft recommendation is available for comment until March 10 on the task force Web site.
Most people born in the U.S. currently are vaccinated against the virus at birth, but there are still between 700,000 and 1.4 million people in the U.S. chronically infected with HBV, the task force notes in the draft recommendation.
"Fortunately, most people in the U.S. are no longer at risk of getting hepatitis B," commented task force member Mark Ebell, MD, of the University of Georgia in Athens.
"Because some countries have high rates of HBV infection, it is important for immigrants from those countries and their doctors to be aware of their risk status and screen them if appropriate," Ebell said in a statement.
The natural history of the illness varies, but an estimated 15% to 25% of people with chronic HBV die of cirrhosis or hepatocellular carcinoma. Those with chronic infection also serve as a reservoir for transmission, the agency noted.
After immunization programs began in 1991, the number of reported acute symptomatic cases of HBV infection decreased from more than 20,000 cases annually in the mid-1980s to 2,890 cases in 2011, the task force noted.
But because of under-reporting, the actual number of new cases every year in the U.S. is likely higher, the draft recommendation says.
The task force said screening tests are very accurate, with sensitivity and specificity both greater than 98%, and likely have small or no associated harm.
Several antiviral agents have been approved for HBV treatment, the task force noted, and there is "convincing evidence" that therapy improves intermediate outcomes, including virologic or histologic improvement or clearance of the HBV e antigen (HBeAg).
And, the task force argued, there is "moderate" evidence that treatment reduces the risk of hepatocellular carcinoma with little associated harm.
In 2004, the task force rejected the idea of screening in the general population, arguing at the time that the potential benefits were smaller than the risks.
Since then, the CDC and the American Association for the Study of Liver Diseases have recommended screening for HBV infection in high-risk individuals, with definitions similar to those of the task force.