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Three best practice guidelines for treating HBV

In an effort to accomplish the goals of the national hepatitis B virus (HBV) elimination plan, a task force from the US Centres for Disease Control and Prevention (CDC) and the American College of Physicians (ACP) has developed three best practice guidelines for treatment of HBV.

Researchers conducted a narrative literature review of current clinical guidelines, systematic reviews, and randomised trials published between 2005 and 2017. Current recommendations for care, which vary from organisation to organisation, 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.”

Background: Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centres for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care.
Methods: A narrative literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies on hepatitis B vaccination, screening, and linkage to care published between January 2005 and June 2017 was conducted.

Best Practice Advice 1: Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including haemodialysis patients), or HIV infection; travellers to HBV-endemic regions; and adults seeking protection from HBV infection.
Best Practice Advice 2: Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including haemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.
Best Practice Advice 3: Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for post-test counselling and hepatitis B–directed care.

Winston E Abara; Amir Qaseem; Sarah Schillie; Brian J McMahon; Aaron M Harris

[link url=""]Infectious Disease Advisor report[/link]
[link url=""]Annals of Internal Medicine best practice statements[/link]

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