The Frontline Role of Primary Care in Hepatitis B Care
Chronic infection of the liver by hepatitis B virus (HBV) remains a significant public health concern in the U.S. and around the world, particularly among at-risk populations. Although many people who are infected are unaware, the infection slowly, quietly damages livers, often to a point beyond repair.
Although it does not currently have a cure, HBV has both a highly effective vaccine and a powerful treatment that can prevent serious liver damage. This fact places a priority on early detection and vaccination to prevent the societal burden of this chronic infection and prevent long-term complications like cirrhosis and liver cancer.
Why Does Primary Care Matter?
PCPs are often the first—and sometimes only—healthcare contact for many patients. This means they are in a unique position to identify at-risk individuals, recommend or provide appropriate screening, and administer or refer for vaccination, without requiring the initiative of the patient.
Who Should Be Screened?
The U.S. Centers for Disease Control and Prevention (CDC) recommend screening for:
- Everyone over the age of 18, regardless of their vaccination status, at least once using a triple panel test.
- All infants born to HBsAg-positive people for HBsAg and antibody to hepatitis B surface antigen (anti-HBs) seromarkers.
- All pregnant people during each pregnancy, preferably in the first trimester, regardless of vaccination status or history of testing. Individuals with a history of appropriately timed triple panel screening without subsequent risk for exposure to HBV (no new HBV exposures since triple panel screening) only need HBsAg screening rather than the triple panel test.
- People at increased risk according to the U.S. Preventive Services Task Force (USPTF)
HBV and its risk factors can be stigmatizing. Some patients may not feel comfortable disclosing risk factors, so, to decrease stigma and increase access to screening, it is recommended that everyone who asks for HBV screening receive it regardless of disclosure of risk.
Screening for HBV
CDC now recommends the use of the triple panel test. Any periodic follow-up testing can use tests as appropriate based on the results of the triple panel.
| Triple Panel Test Results Interpretation | ||||
| HBsAg Hepatitis B Surface Antigen |
Anti-HBs (HBsAb) Hepatitis B Surface Antibody |
Anti-HBc (HBcAb) Hepatitis B Core Antibody |
Interpretation | Next Steps |
| – | – | – |
Not Immune – Not protected Has not been infected, but still at risk for possible hep B infection. |
Vaccine is needed. |
| – | + | + |
Immune Controlled – Protected Surface antibodies present due to natural infection and has recovered. Cannot infect others. |
No vaccine is needed. |
| – | + | – |
Immune – Protected Has been vaccinated. Does not have the virus and has never been infected. |
No vaccine is needed. |
| + | – | + |
Infected HBV is present and virus can spread to doctors. |
More testing needed and treatment may be necessary. |
| – | – | + |
Could Be Infected Result unclear – possible past or current HBV infection. |
More testing needed. |
A Note for Healthcare Providers: Prevention through Vaccination
Remember – safe and effective vaccines are available! Ensure that all patients receive the hepatitis B vaccination series at birth and double-check the vaccination status of adults, especially those who might not have had a birth dose and come from high-prevalence communities, such as immigrants from many Asian countries.
Primary care providers can be a powerful force in normalizing screening and vaccination during routine visits for conditions like HBV that have attached stigma. Research has shown that linguistically and culturally relevant support tools like educational apps can effectively increase patient interest and follow-through in HBV screening in a non-threatening manner.
Be sure to deploy a non-judgmental approach to discussing risk factors. Many cases of chronic HBV infection occur at birth, and no personal or lifestyle choices “earn” someone the disease or disqualify them from comprehensive care.
Though effects can be dire, there is great hope for individuals with chronic HBV infection to enjoy long, healthy lives with proper care, management, and medical surveillance. Early detection can save lives!
Once a patient has received screening and you identify a chronic HBV infection, it may be an appropriate time to refer to hepatology or infectious disease for ongoing treatment. Check in at the next opportunity to ensure your patient has been linked to this life-saving care. If they hesitate to follow up, reiterate the benefits and the dangers of hepatocellular carcinoma, the third-deadliest cancer.
As a primary care provider, you can make a meaningful difference in hepatitis B prevention and long-term liver health.
The statements and opinions presented in this blog post are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors, or the Methodology Committee.