Task Force Recommends Hep B Screening for High-Risk People
MONDAY May 26, 2014, 2014 -- Doctors should regularly screen people at high risk for contracting the hepatitis B virus, which causes chronic illness and can lead to liver cancer if left untreated, a national panel of health experts has recommended.
The U.S. Preventive Services Task Force advised that specific groups of people should undergo screening for hepatitis B, including:
- People born in countries with a high rate of infection, mainly in Asia, sub-Saharan Africa, the Pacific Islands, the Middle East and Eastern Europe.
- Those who share risk factors similar to those for HIV, including injection drug users, men who have sex with men, and people living with or having sex with someone with a hepatitis B infection.
- Patients with a weakened immune system or who are undergoing treatment for kidney failure.
There is no cure for hepatitis B. But a vaccine now exists and antiviral treatments have improved to the point that the virus can be kept in check, said Dr. Roger Chou, an assistant professor at Oregon Health & Science University in Portland and director of the Pacific Northwest Evidence-based Practice Center.
"We have treatments that are effective at suppressing the virus and at improving abnormalities in the liver, so we can prevent some of the damage that occurs due to chronic hepatitis B," said Chou, who served as lead author for the evidence review that formed the basis of the task force's recommendation.
Currently, as many as a quarter of people with chronic hepatitis B infections die from cirrhosis (scarring) of the liver or liver cancer.
"The evidence was pretty clear that there's a significant benefit for people who are at high risk," Dr. Mark Ebell, a task force member and an associate professor of epidemiology and biostatistics at the University of Georgia, Athens.
The recommendation statement is published in the May 26 issue of the Annals of Internal Medicine.
Hepatitis B is becoming less common in the United States due to the success of vaccination programs started in the 1990s, Ebell said.
But there are still as many as 2.2 million people in the United States who are chronically infected with hepatitis B. The task force hopes that screening programs will help get these folks the treatment they need.
The task force previously issued a recommendation that all pregnant women in the United States should be screened for hepatitis B.
Another study in the same journal found that treating all babies born of mothers infected with hepatitis B with immunotherapy right after delivery pays off.
Kaiser Permanente researchers gave infants in the study the hepatitis B vaccine and antibodies within 12 hours of birth, and found the babies were much less likely to end up infected with the virus.
By detecting hepatitis B in expecting mothers and providing treatment to their babies, the doctors were able to reduce infection rates to 0.75 infected newborns out of every 100 births between 1997 and 2010. Prior to this approach, as many as 40 percent of infants born to infected mothers developed chronic hepatitis B infection, the researchers said.
The new task force screening recommendations are consistent with guidelines previously issued by the CDC and the American Association for the Study of Liver Diseases, Ebell said.
People who fall into one of these high-risk groups should ask their doctor for screening, Chou said, noting that there's a health benefit even for those who test negative for hepatitis B.
"If you're at high risk and you test negative, you can get the vaccine and then be protected against contracting hepatitis B," he said.
The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. They make recommendations about clinical preventive services such as screenings, counseling services and preventive medications.
The Affordable Care Act has given new muscle to the task force, requiring health plans to cover for free the preventive services and screenings recommended by the panel.
Visit the U.S. Centers for Disease Control and Prevention for more on hepatitis B.
Posted: May 2014