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Screening

Patients with chronic hepatitis B can remain asymptomatic for decades. Therefore, many people infected with the virus don’t even know they have it. CHB patients may also be unaware that they may be at risk of disease progression, such as cirrhosis and liver cancer, and that they present a transmission risk to others.1,2

Appropriate screening is a vital step in educating patients and their loved ones about the virus, whether they are infected, and whether they should get vaccinated.1

View the recommended serologic tests

Chronic hepatitis B infection is a significant public health problem worldwide.2

  • Approximately 90% of the world’s population lives in regions of intermediate and high hepatitis B endemicity1
  • In 2015 alone, an estimated 887,000 people died due to complications from hepatitis B, including cirrhosis and HCC3

In the United States, there are up to 2 million people living with chronic hepatitis B; however, the majority of them are unaware of their infection.4

  • Up to 95% of people with chronic hepatitis B in the United States migrated from intermediate and high prevalence countries5
  • In 2015, hepatitis B infection was an underlying cause of more than 1,700 deaths6

An estimated 257 million people are living with chronic hepatitis B worldwide4,7

Estimated people living with chronic hepatitis B worldwide

The USPSTF, ACP and CDC, and AASLD guidelines recommend screening the following high-risk groups for hepatitis B:

  • People born in regions where the prevalence of HBV infection is ≥2%2,5,8,9
  • US-born people not vaccinated as infants and whose parents were born in regions having an HBV prevalence of ≥8%5,8,9
  • Household and sexual contacts of persons with HBV infection2,5,8,9
  • All pregnant women8,9,10
  • Men who have sex with men2,5,8,9
  • Injection drug users2,5,8,9
  • Individuals infected with HCV or HIV2,5,8,9
  • People with certain medical conditions2,5,8,9
    • Needing immunosuppressive therapy
    • Undergoing hemodialysis
  • People with elevated ALT or AST of unknown etiology8,9
  • Donors of blood/organ/tissue8,9
  • Healthcare providers8,9
  • People exposed to bodily fluids8,9
  • Inmates8

Serologic tests to order

The CDC recommends ordering the following three tests to screen for hepatitis B1:

  • All three tests are required to correctly determine next steps
    • Different serologic “markers” or combinations of markers are used to identify different phases of hepatitis B infection and to determine whether a patient has acute or chronic hepatitis B infection; is immune to hepatitis B as a result of prior infection or vaccination; or is susceptible to infection11
      • HBsAg:
        A protein on the surface of HBV; it can be detected in high levels in serum during acute or chronic HBV infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.11
      • Anti-HBs:
        The presence of anti-HBs is generally interpreted as indicating recovery and immunity from HBV infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.11
      • Anti-HBc:
        Appears at the onset of symptoms in acute HBV infection and persists for life. The presence of anti-HBc indicates previous or ongoing infection with HBV for an undefined time frame.11

Serologic tests can be used to identify the phase of hepatitis B infection and vaccination status of the patient.11,12

Hepatitis B serologic test results

Hepatitis B serologic test results

Isolated anti-HBc—the presence of anti-HBc in the absence of any other serological markers of HBV infection—may indicate prior infection with spontaneous recovery or occult hepatitis B.11,12

If follow-up or treatment is necessary, referral to an appropriate specialist may be required.12

  • a Anti-HBc refers to total anti-HBc.11
  • b Patient is chronically infected if HBsAg+ for ≥6 months.12
  • c Patients who are anti-HBc+ should be monitored closely during and after the administration of cytotoxic chemotherapy for signs of HBV reactivation.12
  • d Patients with cirrhosis may need to be monitored for HCC per the AASLD guidance.9
  • e Suggests multiple interpretations, including11:
    • The patient may be distantly immune and the test is not sensitive enough to detect very low levels of anti-HBs in the serum
    • The result may be a false-positive anti-HBc, meaning the patient is susceptible to HBV
    • An undetectable level of HBsAg may be present in the serum and the patient is in fact chronically infected
    • The patient may be recovering from an acute HBV infection

AASLD=American Association for the Study of Liver Diseases; ACP=American College of Physicians; ALT=alanine aminotransferase; anti-HBc=antibody to hepatitis B core antigen; anti-HBs=antibody to the hepatitis B surface antigen; AST=aspartate transaminase; CDC=Centers for Disease Control and Prevention; CHB=chronic hepatitis B; HBsAg=hepatitis B surface antigen; HBV=hepatitis B virus; HCC=hepatocellular carcinoma; HCV=hepatitis C virus; HIV=human immunodeficiency virus; USPSTF=US Preventive Services Task Force.