G2 Insider: Hepatitis B Screening, Follow-Up Testing ‘Suboptimal’

Among veterans testing positive for hepatitis B surface antigen (HBsAg), the initial screening test for hepatitis B virus (HBV), the rates of recommended follow-up serologic testing for treatment stratification is low, according to an abstract presented at the annual meeting of the American Association for the Study of Liver Diseases (AASLD; Boston; Nov. 7-11). While the chronic HBV infection seems to be substantially higher in veterans, compared to the general U.S. population, improved adherence to testing guidelines is likely needed by care providers both in and out of the Department of Veterans Affairs (VA), the authors say.

Data from the VA Corporate Data Warehouse was used to identify adult patients with any positive HBsAg result from 2002 to 2014 and to determine if additional serologic and biochemical testing recommended by the AASLD (HBeAg, HBeAb, HBcIgM, HDVAb, HDV RNA, HCVAb, HIVAb) was performed at any time following the positive HBsAg result. The researchers also determined if alanine aminotransferase (ALT; liver function testing) and HBV DNA testing was performed within 180 days from the first HBsAg-positive result.

The researchers found that HBsAg screening was performed on 2,643,089 veterans, with 1.9 percent (n=50,109) testing positive. The vast majority of these positive results were new diagnoses (95.2 percent). Just over three-quarters (77.6 percent) of those testing positive had an ALT liver function test within six months of the initial positive result, while only 14.2 percent had HBV DNA polymerase chain reaction testing. Among HBsAg-positive individuals, 17.2 percent received testing for HBcIgM, 23.7 percent for HBeAg, 20.7 percent for HBeAb, 78.2 percent for HCV Ab, 33.2 percent for HIV Ab, and 4.1 percent for HDVAb or HDV RNA.

These “suboptimal” rates of HBV serologic testing are likely to directly impact patient outcomes, the authors suggest, as appropriate testing is necessary to determine a patients’ qualification for treatment. As for initial screening, which the authors also determined was low, the U.S. Centers for Disease Control and Prevention calls for screening all persons born in countries where hepatitis B is endemic (more than 2 percent, like Asia and Africa), health care workers, HIV-positive patients, men who have sex with men, and pregnant women.

“While other chronic viral infections such as hepatitis C and HIV have received tremendous educational efforts hepatitis B has received far less attention,” the study’s principal investigator, David Kaplan, M.D., from the Philadelphia VA Medical Center, said in a statement. “We suspect that in the baby boomer population there is a significant population of injection drug use-related chronic HBV that is undiagnosed and will not be captured by current U.S. [Preventive] Screening Task Force screening guidelines.”

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