The CDC recently released new recommendations for Screening and Testing for Hepatitis B Virus infection. These guidelines mirror existing CDC Recommendations for Hepatitis C Screening Among Adults - 2020. Both recommendations call for universal testing of ALL adults, 18 years and older, at least once for hepatitis B and hepatitis C, with additional testing based on individual risk. Both recommendations call for universal testing of all pregnant individuals with each pregnancy.

According to the CDC an estimated 580,000 to 2.4 million persons are living with HBV infection in the United States; approximately two thirds are unaware of their infection. Coincident with the opioid use epidemic in the last decade, we have seen substantial increases in the rates of HCV infection. 107, 300 cases of chronic HCV were reported in the US in 2020.

CDC’s recommendations call for universal HBV screening to include testing for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and antibody to hepatitis B core antigen (anti HBc). Recommendations for universal HCV screening include testing for HCV antibodies (anti-HCV) with testing for HCV RNA in those who are anti-HCV positive.

Treatment

• HBV – While there is no curative treatment for chronic HBV infection, antiviral medication can achieve sustained suppression of HBV replication and remission of liver disease. Individuals with chronic HBV infection should be monitored for progression of liver disease and the development of hepatoma. Individuals with chronic HBV are best referred for evaluation to a provider experienced in managing such infections.
• HCV – Highly effective, well tolerated oral therapy exists for hepatitis C. Completion of 8–12-week standard regimens can achieve >95% cure rates. In most cases primary care providers are best positioned to treat HCV. HCVguidelines.org provides latest information on testing, management, and treatment of HCV.

Prevention

• HBV- Current HBV vaccination guidance includes a universal recommendation for child vaccination. All non-infected non-immune adults should be offered vaccination to protect against future infection.
• HCV – There is no vaccine to prevent HCV infection. Curative treatment not only prevents the sequalae of chronic HCV infection but prevents further transmission. Uninfected, infected, and treated individuals should be counseled on risk factors for HCV infection and measures they can take to reduce their risk of infection.

Reactivation\reinfection

• HBV – Individuals who test positive for anti-HBc but have no evidence of illness are still at risk for reactivation of disease. This can occur spontaneously, but most often is associated with immunosuppression, such as when receiving treatment for rheumatologic or oncologic disorders. Treatment of HCV in an individual co-infected with HBV & HCV has been associated with reactivation of HBV.
• HCV – Successful treatment, or spontaneous clearance, of HCV infection does not lead to protective immunity; reinfection can occur. Individuals with ongoing risks for HCV infection should be counseled on risk reduction and screened regularly to assess for infection or reinfection.