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Chronic hepatitis B virus (HBV) infection affects approximately 350 million people worldwide and is the leading cause of hepatocellular carcinoma. In the U.S., between 800,000 and 1.4 million people have chronic HBV infection, and the prevalence is expected to rise because of the continued influx of immigrants from high-prevalence countries. Given the changing epidemiology of HBV infection in the U.S., new evidence supporting screening, and recent improvements in treatment regimens, the CDC has revised its screening guidelines.
Previous screening recommendations called for hepatitis B surface antigen (HBsAg) testing only in the following groups: pregnant women, infants born to HBsAg-positive mothers, persons with HIV infection, persons exposed to the blood or other bodily fluids of suspected HBV-infected sources, household contacts and sex partners of persons with HBV infection, and persons born in countries with HBsAg prevalence ≥8%.
The new recommendations include three more groups in which HBsAg testing should be performed:
Persons born in geographic regions in which HBsAg prevalence is ≥2%: Rates of hepatocellular carcinoma in other countries continue to be high, especially in Asia and the Pacific Islands.
Injection-drug users: HBV infection has been identified in 2.7% to 11.0% of this population.
Men who have sex with men: The prevalence of chronic HBV infection in this population is estimated to be 9% to 17%.
Weinbaum CM et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep 2008 Sep 19; 57:1.
Comment
These expanded screening guidelines reflect the changing epidemiology of chronic HBV infection and the proven benefits of screening. Clinicians should be aware of these new recommendations, especially the expansion of screening to foreign-born persons from areas with intermediate HBsAg prevalence (≥2%). A complete list of countries and prevalences of HBsAg is available from the CDC.