On May 27, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation(www.uspreventiveservicestaskforce.org) that screening for hepatitis B virus (HBV) infection should be performed in people at high risk for infection. The recommendation was based on a systematic review of evidence(www.uspreventiveservicestaskforce.org) conducted to update the task force's 2004 recommendation statement.
An estimated 700,000 to 2.2 million people in the United States have chronic HBV infection, according to sources cited in the USPSTF's recommendation statement. People considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, HIV-positive patients, injection drug users, people who have regular contact with someone who is HBV-infected and men who have sex with men.
"An estimated 15 percent to 25 percent of people with chronic HBV infection die of cirrhosis or hepatocellular carcinoma," the USPSTF recommendation states. "Screening for HBV infection could identify chronically infected persons who may benefit from treatment or other interventions, such as surveillance for hepatocellular carcinoma."
The AAFP agreed with the USPSTF stance in its own recommendation to screen people at high risk for HBV infection. But it also continues to recommend against screening the low-risk, general asymptomatic population for chronic HBV infection.
- The U.S. Preventive Services Task Force (USPSTF) and the AAFP recommend that screening for hepatitis B virus (HBV) infection be performed in people at high risk for infection.
- The AAFP also recommends against screening the general asymptomatic population for chronic HBV infection.
- Doug Campos-Outcalt, M.D., M.P.A, the AAFP liaison to the USPSTF, said reasons behind the AAFP's recommendation against screening the low-risk population included very low rates of HBV infection in those not at high risk.
"The AAFP Commission on Health of the Public and Science felt it was important to continue to recommend against screening the low-risk population," said Doug Campos-Outcalt, M.D., M.P.A., of Phoenix. "The AAFP agrees with screening those at high risk, but believes we should not offer universal screening for hepatitis B."
Campos-Outcalt, the AAFP liaison to the USPSTF, said the reasoning behind the AAFP's recommendation against screening the low-risk population included the fact that the rates of HBV infection in those not at high risk are very low. "In addition," he added, "an increasing percentage of the population is immune secondary to childhood vaccination. HBV has been on the recommended routine immunization schedule for about 25 years."
In 2004, the USPSTF also recommended against screening for chronic HBV infection in asymptomatic patients in the general population, finding that:
- the prevalence of HBV infection in the general population was low;
- most infected people did not develop chronic infection, cirrhosis or HBV-related liver disease; and
- screening for HBV infection in the general population did not improve long-term health outcomes.
But in its current recommendation, the USPSTF focused on high-risk populations and found new evidence(www.uspreventiveservicestaskforce.org) indicating that antiviral regimens improve health outcomes and reduce incidence of hepatocellular carcinoma and that HBV vaccination is effective in decreasing the rate of disease acquisition in high-risk populations.
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