Hepatitis B Virus Screening Guidelines

Primary Screening Tests

• The American College of Physicians recommends hepatitis B surface antigen (HBsAg) testing as the primary screening test to identify active HBV infection (acute or chronic) 1, 2
• Confirmatory testing should be performed for initially reactive HBsAg results using a licensed, neutralizing confirmatory test 3

Comprehensive Screening Panel

• The American Academy of Family Physicians recommends testing for HBsAg to detect active infection 1, 4
• The American Gastroenterological Association indicates that hepatitis B core antibody (anti-HBc) testing can indicate previous or ongoing infection 5, 6
• The American College of Physicians recommends hepatitis B surface antibody (anti-HBs) testing to indicate immunity due to vaccination or resolved infection 1, 4

Implementation Considerations

• The American Gastroenterological Association recommends that all adults aged ≥18 years should be screened at least once in their lifetime 6
• The Centers for Disease Control and Prevention recommends testing for persons at risk for HBV reactivation before starting immunosuppressive therapy 5, 6
• The American Academy of Family Physicians recommends screening for persons from countries with HBsAg prevalence ≥2% (Asia, Africa, Pacific Islands, parts of South America, Eastern Europe) 4, 7
• The American College of Physicians recommends screening for persons with high-risk behaviors (injection drug use, men who have sex with men) 7, 2
• The American Academy of Family Physicians recommends screening for HIV-positive individuals 4, 3
• The American Academy of Family Physicians recommends screening for household contacts or sexual partners of HBV-infected persons 4, 7

Screening Algorithm

• The American Gastroenterological Association recommends initial screening with HBsAg, anti-HBc, and anti-HBs testing 6, 4
• If HBsAg positive, it indicates active HBV infection (acute or chronic) 1, 2
• If HBsAg negative but anti-HBc positive, it indicates past infection or occult HBV 6, 8
• If anti-HBs positive only, it indicates immunity from vaccination 1

Special Considerations

• The American Gastroenterological Association recommends both HBsAg and anti-HBc testing for patients at risk of HBV reactivation (e.g., those receiving immunosuppressive therapy) 5, 6
• The American Academy of Family Physicians recommends periodic screening for persons with ongoing risk factors (e.g., current injection drug use, multiple sexual partners) 4, 7
• The American Academy of Family Physicians recommends screening regardless of vaccination history, as breakthrough infections can occur 4, 7

Interpretation of Results