Why screen your at-risk patients for HBV?

To identify and diagnose chronically infected patients1
who may need treatment—most people with chronic hepatitis B are unaware of their infection2
To reduce transmission of HBV infection
to others, including household members and sexual partners
To help patients avoid serious complications
such as fibrosis, cirrhosis, and HCC through appropriate medical management3
CHB=chronic hepatitis B; HBV=hepatitis B virus; HCC=heptatocellular carcinoma.

Identify your patients with chronic hep B

In the US, the approximately 2.2 million people living with chronic hep B go largely undiagnosed and untreated.4,5

About 2 out of 3 people with CHB in the US are unaware of their infection2

Donut graph showing about 70%~70%
of people with CHB are undiagnosed2
Donut graph showing more than 95%>95%
of chronically infected people are untreated2,a
aOverall, <10% of those who meet medical eligibility for HBV treatment in the US receive medication.2

Do you have patients with undiagnosed CHB?

CHB is often asymptomatic and patients can be without symptoms for many years.6

Screen patients to reduce the transmission of HBV infection

CHB patients who are unaware of their infection are at risk for transmitting the virus to others.6 Screen at-risk patients to:

Identify chronically infected patients and allow for intervention to prevent transmission

Identify unprotected patients and link them to HBV vaccination9

Chronic hep B can cause serious complications

Patients who don’t experience symptoms may not recognize appropriate disease management in avoiding serious consequences.

CHB disease progression

Percentages in the figure above are 5-year cumulative incidence rates.11
bChronic infection is defined as HBsAg+ for ≥6 months.12
HBsAg=hepatitis B surface antigen.

Risk factors associated with cirrhosis and HCC13,14

Host FactorsCirrhosis13HCC13,14
>40 years of age
Male gender
Immune compromised
Family history of HCC
Born in Sub-Saharan Africa or Asia
Viral / Disease FactorsCirrhosis13HCC13,14
High viral load (>2000 IU/mL)
Elevated ALT
High serum AFP
Prolonged time to HBeAg seroconversion
Development of HBeAg-negative CHB
Genotype C
BCP or PC mutations
Presence of cirrhosis
EnvironmentalCirrhosis13HCC13,14
HCV, HIV, or HDV coinfections
Heavy alcohol use
Metabolic syndrome (obesity, diabetes)
Alfatoxin
Smoking
ALT=alanine aminotransferase; AFP=alpha-fetoprotein; BCP=basal core promoter; CHB=chronic hepatitis B; HBeAg=hepatitis B e antigen; HBsAg=hepatitis B surface antigen; HCC=hepatocellular carcinoma; HCV=hepatitis C virus; HDV=hepatitis D virus; HIV=human immunodeficiency virus; PC=precore.
Are your patients at risk?

“Implementing steps to identify, follow, refer, and [appropriately] treat persons with CHB infection by all primary care and specialist healthcare providers can have a major impact on reducing the occurrance of HCC and cirrhosis in infected persons.”

-Brian J. McMahon, MD, The American Journal of Medicine15

See screening protocols

Information for healthcare professionals

AASLD=American Association for the Study of Liver Diseases; ACP=American College of Physicians; CDC=Centers for Disease Control and Prevention; USPSTF=U.S. Preventive Services Task Force.
References:
  • Abara W, Qaseem A, Schillie S, et al. Hepatitis B vaccination, screening, and linkage to care: best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167(11):794-804
  • Cohen C, Holmberg SD, McMahon BJ, et al. Is chronic hepatitis B being undertreated in the United States? J Viral Hepat. 2011;18:377-383.
  • Centers for Disease Control and Prevention. Asian Americans and Pacific Islanders and chronic hepatitis B. CDC website. https://www.cdc.gov/hepatitis/populations/api.htm. Last reviewed August 27, 2019. Accessed October 15, 2019.
  • Gish R, Cohen C, Block J, et al. Data supporting updating estimates of the prevalence of chronic hepatitis B and C in the United States. Hepatology. 2015;62:1339-1341.
  • Kowdley K, Wang C, Welch S, et al. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56:422-433.
  • Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2008.
  • Centers for Disease Control and Prevention. Hepatitis B FAQs for the public. Updated April 30, 2018. https://www.cdc.gov/hepatitis/hbv/bfaq.htm. Last reviewed September 10, 2019. Accessed October 15, 2019.
  • World Health Organization. Hepatitis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Updated July 18, 2019. Accessed October 15, 2019.
  • Terrault N, Lok A, McMahon B, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-159.
  • World Health Organization (WHO). Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva, Switzerland: WHO Press; 2015.
  • Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48(2):335-352.
  • LeFevre ML, on behalf of the United States Preventive Services Task Force. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(1):58-66.
  • Terrault N, Bzowej N, Chang K, et al. ASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261-283.
  • Tong M, Pan C, Han S, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47(8):1181-1200.
  • McMahon, BJ. Implementing evidenced-based practice guidelines for the management of chronic hepatitis B virus infection. Am J Med. 2008 Dec;121(12 Suppl):S45-52.