Hepatitis B screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]


High-risk groups should be tested for HBV infection. These include immigrants/refugees from areas of intermediate or high endemicity, persons with chronically elevated aminotransferases, immunocompromised individuals, and persons with a history of injection drug use(IDU).[1] Additionally, screening for hepatocellular carcinoma should extend to any HBV carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL.[2]


Recommendations for Persons Who Should Be Screened for HBV Infection

The following groups should be tested for HBV infection:[1]

  • Persons born in high or intermediate endemic areas
  • United States–born people who were not vaccinated as infants and whose parents were born in regions with high HBV endemicity
  • Persons with chronically elevated aminotransferases
  • Persons who require immunosuppressive therapy
  • Men who have sex with men
  • People with multiple sexual partners or history of sexually transmitted disease
  • Incarcerated people
  • Persons who have ever used injecting drugs, dialysis patients, HIV- or HCV-infected individuals, pregnant women, and family members, household members, and sexual contacts of HBV-infected people
  • Testing for HBsAg and anti-HBs should be performed, and seronegative persons should be vaccinated. (Grade I Recommendation)
Group Screening Recommendations
Pregnant women
  • All pregnant women should screen (HBsAg testing) at the first prenatal visit
  • Re-screen women with unknown HBsAg status or new or continuing risk factors
  • Refer women who test positive for counseling and medical management
  • Administer hepatitis B vaccine and hepatitis B immune globulin to exposed infants within 12 hours of birth
Asymptomatic/Nonpregnant adolescents and adults at high risk (HBV)
  • Risk Assessment:
    • Persons born in countries and regions with a high prevalence of HBV infection (≥2%)
    • U.S.-born persons not vaccinated as infants whose parents were born in regions with a very high prevalence of HBV infection (≥8%),
    • HIV-positive persons
    • Injection drug users
    • Men who have sex with men
    • Household contacts or sexual partners of persons with HBV infection
  • Screening Tests:
    • (HBsAg) test followed by a licensed, neutralizing confirmatory test
    • Testing for antibodies to HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc) (distinguish between infection and immunity)

Recommendations for HCC Screening: AASLD Practice Guidelines

The following groups should be screened with US examination every 6-12 months: (Grade II-2)[2]

  • HBV carriers at high risk for HCC such as Asian men over 40 years and Asian women over 50 years of age
  • People with cirrhosis
  • People with a family history of HCC
  • Individuals of African descent over 20 years of age
  • Any carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL

For HBV carriers at high risk for HCC who are living in areas where US is not readily available, periodic screening with AFP should be considered. (Grade II-2)


  1. 1.0 1.1 U.S Preventive Services Task Force. Hepatitis B. (2016) https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatitis+b Accessed on October 10th, 2016
  2. 2.0 2.1 AASLD guidelines for treatment of chronic hepatitis B. Hepatology (2016) http://onlinelibrary.wiley.com/doi/10.1002/hep.28156/full Accessed on October 10th, 2016

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