Abstract
BackgroundIn low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC's recommendations identified infected individuals and which risk-factor groups needing testing.MethodsDuring a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants' eligibility for HBV-testing was asked to study medical professionals.Results85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8–100) than physicians' discretion (Sensitivity = 87.1%, 95%CI: 78.0–93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3–47.6) (p<0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI: 29.6–32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician's discretion for testing HBV was not significantly associated with participants' geographical origin or IDU.ConclusionsMissed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.
Highlights
Chronic hepatitis B virus (HBV) infection affects more than 350 million people worldwide, of whom 600,000 die each year of liverrelated diseases associated with long-term infection [1,2]
Among the more commonly focused groups of individuals at risk for HBV-infection, 43.8% were born in a country of intermediate or high HBV-endemicity, 45.7% had .1 sexual partner 12-months prior, 23.1% had either no healthcare or healthcare assistance [currently using programs provided by the French government in the form of a Couverture Medicale Universelle (CMU) or an Aide Medicale d’Etat (AME)], 10.6% were men who have sex with men (MSM), and 0.6% were intravenous drug users (IDUs)
We observed that individuals coming from intermediate and high HBV-endemic regions are in most need of HBV-testing and, while these individuals were more likely to be
Summary
Chronic hepatitis B virus (HBV) infection affects more than 350 million people worldwide, of whom 600,000 die each year of liverrelated diseases associated with long-term infection [1,2]. In Western countries, despite a relatively low prevalence and widely available access to vaccination, HBV remains one of the most frequent chronic infectious diseases, with a prevalence reaching 14 million in the European region compared to 9 million with hepatitis C virus (HCV) and 1.5 million with human immunodeficiency virus (HIV) [3]. Despite this high disease burden, few HBV infected patients are aware of their chronic infection. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC’s recommendations identified infected individuals and which risk-factor groups needing testing
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