Screening for chronic hepatitis B.

Hepatitis B virus (HBV) infection is a major public health problem worldwide. More than 2 billion people have been infected; more than 350 million present with chronic HBV infection. A significant proportion (15-40%) of chronic HBV infected patients develop liver cirrhosis, liver failure, and primary hepatocellular carcinoma (HCC), making chronic hepatitis B one of the 10 major causes of death worldwide. The practice of preventive medicine involves three primary tasks: Screening, counseling, and immunization or chemoprophylaxis. Screening healthy individuals incurs an ethical obligation on the clinician. Persons who are most likely to be actively infected with HBV should be tested for chronic HBV infection. Testing should include a serologic assay for HBsAg offered as a part of routine care and be accompanied by appropriate counseling and referral for recommended clinical evaluation and care. To determine susceptibility among persons who are at ongoing risk for infection and recommended for vaccination, total anti-HBc or anti-HBs also should be tested at the time of serologic testing for chronic HBV infection. Recommendations related to screening for chronic HBV infection have been summarized in this article.