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Am Fam Physician. 2014;90(11):795

Clinical Question

Who should be screened for hepatitis B virus infection?

Bottom Line

The U.S. Preventive Services Task Force (USPSTF) recommends hepatitis B virus screening for human immunodeficiency virus–positive persons, users of illicit injection drugs, men who have sex with men, household contacts or sex partners of infected persons, and persons born in countries with a high prevalence of hepatitis B virus infection or who are born to parents who were born in regions with very high prevalence of hepatitis B virus infection. This is a B recommendation (moderate certainty of moderate benefit) and is an update of the 2004 recommendation, which recommended against screening the general population. In another statement, the USPSTF also recommends screening pregnant women. (Level of Evidence = 5)

Synopsis

Although there is no direct evidence from randomized controlled trials, the USPSTF concludes the associated harm from screening is low. Early detection can result in early antiviral treatment that can prevent cirrhosis, hepatic failure, and liver cancer. The hepatitis B surface antigen (HBsAg) has a sensitivity and specificity of greater than 98%, and can detect acute and chronic infection. Chronic hepatitis B virus infection is diagnosed with a positive HBsAg for at least six months. This guideline included a high-quality literature review and the committee included a methodologist, stakeholders, and a patient representative. The guideline focused on patient-oriented outcomes, and was written by committee members without intellectual, professional, or financial conflicts of interest.

Study design: Practice guideline

Funding source: Government

Setting: Various (guideline)

References: LeFevreMLScreening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med2014; 161( 1): 58– 66.

ChouRDanaTBougatsosCBlazinaIKhanguraJZakherBScreening for hepatitis B virus infection in adolescents and adults: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med2014; 161( 1): 31– 45.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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