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Hepatitis B Chronic Test Recommendations

Recently, the Centers for Disease Control (CDC) released new guidelines which expand the testing recommendations for chronic hepatitis B (HBV) infections. Although the incidence of new HBV infections has declined due to vaccine availability, there are an estimated 800,000 to 1.4 million people with chronic HBV infections in the U.S. Because the disease can be asymptomatic for years, those with chronic HBV may be unaware of their infection, and are at high risk for late complications of the disease as well as potentially transmitting the virus. There are an estimated 2,000 to 4,000 deaths in the U.S. annually attributed to hepatitis B infection, mostly due to cirrhosis and liver cancer.

Previously, the CDC recommended hepatitis B screening for pregnant women & infants of HBV-infected mothers, household contacts and sex partners of HBV-infected individuals, HIV-infected people, persons born in countries with HBV prevalence >8%, and post-occupational exposure. The new guidelines expand the testing recommendation to include essentially three new groups:

  • Patients receiving cytotoxic or immunosuppressive therapy, including chemotherapy, organ transplant recipients, and those treated for rheumatologic or gastroenterologic disease.
  • People born in geographic regions with HBV prevalence >2%. This includes Eastern Europe, Asia, the Middle East, and Pacific Islands.
  • People with behavioral exposures to HBV, including past or current injection drug users, and men who have sex with men.

Hepatitis B surface antigen (HBsAg) is the serologic marker primarily used to identify and define chronic hepatitis B. Chronic infection is defined as the absence of concurrent hepatitis B core IgM antibody (IgM anti-HBc) and by persistence of HBsAg or HBV DNA for at least 6 months. All HBsAg-positive persons are considered infectious. In addition to HBsAg, serologic testing for hepatitis B surface antibody (anti-HBs) and total core antibody (anti-HBc) is advised for immuno-suppressed patients.

The new guidelines also include recommendations for medical management of chronic HBV and are available through www.cdc.gov, MMWR Recommendations and Reports, September 19,2008; Vol. 57 (RR-8).

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