Hepatitis B virus is the second-most common cause of viral hepatitis in the United States,(www.cdc.gov) despite the fact that an effective vaccine against the virus is readily available. About 22,000 people become infected with HBV each year, and roughly two-thirds of those who are infected don't know it. This is an important consideration, given that the CDC estimates(www.cdc.gov) that up to 25% of people with chronic HBV infection die prematurely from conditions such as hepatocellular carcinoma or cirrhosis.
A multidisciplinary panel of national HBV experts -- the Hepatitis B Primary Care Workgroup, working in collaboration with the University of Washington's National Hepatitis Training Center -- has provided family physicians and other primary care clinicians easy-to-use guidance on preventing, diagnosing and managing HBV infection, Hepatitis B Management: Guidance for the Primary Care Provider.(www.hepatitisb.uw.edu)
The guidance covers a wide range of related topics and offers hands-on tools, including a chronic HBV testing and management algorithm and a section on interpreting HBV serologic test results. Other sections address topics such as the initial evaluation of patients who test positive for HBV infection, patient counseling, antiviral treatment options and surveillance for hepatocellular carcinoma.
The document also links to various studies and guidelines.
Amy Mullins, M.D., the AAFP's medical director for quality improvement, told AAFP News that the guidance is a valuable resource that collects and organizes information from multiple sources in one place.
"Depending on the family physician and their current practice, the up-to-date treatment options for HBV may be new information," Mullins said. "In any case, the most up-to-date information is always welcome.
"It is reassuring to know a trusted resource is doing the legwork behind the scenes so the busy family physician does not need to scramble to make sure their recommendations are the most up-to-date."
Although the guidance does not specifically address screening for HBV infection, the U.S. Preventive Services Task Force recommends screening in people at high risk for infection(www.uspreventiveservicestaskforce.org) and in pregnant women at their first prenatal visit.(www.uspreventiveservicestaskforce.org) The AAFP supports both recommendations.
The new guidance document is being hosted on the UW National Hepatitis Training Center's free, educational website, Hepatitis B Online.(www.hepatitisb.uw.edu) The website, created with funding from the CDC, features
- a collection of quick reference guides that cover a range of HBV-related topics, including epidemiology, immunizations, treatment initiation, prevention of perinatal transmission, screening for hepatocellular carcinoma and occupational postexposure prophylaxis;
- a series of self-study modules;(www.hepatitisb.uw.edu)
- information on medications used to prevent or treat HBV infection; and
- clinical calculators and substance use screening tools.(www.hepatitisb.uw.edu)
Additional resources will be added to the website through 2021.
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