ACP, CDC Provides Best Practice Advice on Hepatitis B Management

In an effort to accomplish the goals of the national hepatitis B virus (HBV) elimination plan, a task force from the Centers for Disease Control and Prevention (CDC) and the American College of Physicians (ACP) has developed 3 best practice guidelines for treatment of HBV. The guidelines were published in the Annals of Internal Medicine.

Researchers conducted a narrative literature review of current clinical guidelines, systematic reviews, and randomized trials published between 2005 and 2017. Current recommendations for care, which vary from organization to organization, were also included in the review. Researchers further screened selected articles, including those focused on “vaccination, screening, and treatment for chronic HBV infections; barriers to screening and linkage to care; adverse events associated with vaccination; and strategies to increase screening, vaccination, and linkage to an HBV-experienced provider.”

Summaries of the 3 best practice statements are as follows:

Best Practice Advice 1. All unvaccinated adults at risk for HBV — because of sexual, percutaneous, or mucosal exposure — should be vaccinated against HBV. This includes healthcare and public safety workers, adults with chronic liver disease, those with end-stage renal disease or HIV infection, and anyone travelling to HVB-endemic regions.

Best Practice Advice 2. High-risk persons should be screened for HBV. This population includes those born in countries with a prevalence of HBV 2% or higher; men who have sex with men; users of injection drugs; people requiring immunosuppressive therapy; those with end-stage renal disease, HIV, or hepatitis C; incarcerated persons; and infants born to mothers with HBV, among others.

Best Practice Advice 3. People who are identified as having HBV (HBsAg-positive) should receive or be referred for posttest counseling and hepatitis B-directed care.

“The burden and costs associated with chronic HBV infection in the United States are high,” the researchers concluded. “Screening in high-risk populations is the first step in the care cascade to identify persons with chronic HBV infection, and vaccination and linkage to care are effective at reducing HBV-associated morbidity and mortality.”

“The best practice advice statements…amplify and complement existing clinical guidelines by reiterating the importance of…vaccination and screening in at-risk persons and linking infected persons to care.” 

To read the full best practice statements, visit the Annals of Internal Medicine.

Reference

Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM; for the High Value Care Task Force of the American College of Physicians and the Centers for Disease Control and Prevention. Hepatitis B vaccination, screening, and linkage to care: best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention [published online November 21, 2017]. Ann Intern Med. doi:10/7362/M17-1106