Hepatitis B: Screening in Primary Care

By: David M. Fettig, MD, Birmingham Gastroenterology Associates

The CDC estimates that 1.2 million people in the United States have chronic Hepatitis B (HBV) but two-thirds do not know they are infected. These unaware patients can have clinically silent infections for decades until developing cirrhosis, end-stage liver disease, or hepatocellular carcinoma (HCC). HBV is transmitted by percutaneous or mucosal exposure to blood or body fluids of an infected person, such as from an infected mother to her newborn during childbirth, through close personal contact within households, through unscreened blood transfusion or unsafe injections in health- care settings, through injection drug use, and from sexual contact with an infected person.

Vaccines for HBV were introduced in the US in 1982. All medically stable infants are vaccinated within 24 hours of delivery and pregnant women are tested for HBV with HBIG immunoprophylaxis also given to infants born to hepatitis B surface antigen (HBsAg)-positive mothers.

Primary Care Physicians are the first line of defense in detecting HBV. Screening should occur (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence (Asia and Pacific Islands), men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.

Patients identified with HBV (HBsAg-positive) can be referred to a Hepatologist for treatment. However, not everyone with chronic hepatitis B infection needs to be treated. This can be difficult for patients to accept when first diagnosed. Current treatments are generally found to be most effective in those who show signs of active liver disease. Treatments for hepatitis B is all oral therapy and highly responsive. The decision to be treated is based on many different parameters and should be decided by a Hepatologist.

Patients with Hepatitis B will require follow-up during and after discontinuation of antiviral therapy to monitor disease progression and possible development of HCC. Similarly, persons with inactive disease require regular monitoring to ensure that they remain inactive carriers or evidence of progression to cirrhosis. The physicians of Birmingham Gastroenterology Associates are prepared to care for patients with Hepatitis B, along with any other form of Viral Hepatitis or Liver Disease.

References: AASLD Hepatitis B Guidelines; CDC Guidelines for Hepatitis B