Roger Chou, MD; Tracy Dana, MLS; Christina Bougatsos, MPH; Ian Blazina, MPH; Jessi Khangura, MD; Bernadette Zakher, MBBS
Note: This review was conducted by the Pacific Northwest Evidence-based Practice Center under contract to AHRQ. AHRQ staff provided oversight for the project and assisted in the external review of the companion draft evidence synthesis.
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Iris Mabry-Hernandez, MD, MPH, and USPSTF leads Kirsten Bibbins-Domingo, MD, PhD; Mark Ebell, MD, MS; Douglas K. Owens, MD, MS; and Albert L. Siu, MD, MSPH.
Financial Support: By contract HHSA-290-2007-10057-I-EPC3, task order 13, from the AHRQ.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2837.
Requests for Single Reprints: Roger Chou, MD, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239-3098; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Chou, Khangura, and Zakher; Ms. Dana; Ms. Bougatsos; and Mr. Blazina: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239-3098.
Author Contributions: Conception and design: R. Chou, J. Khangura, B. Zakher.
Analysis and interpretation of the data: R. Chou, T. Dana, C. Bougatsos, I. Blazina, J. Khangura, B. Zakher.
Drafting of the article: R. Chou, T. Dana, C. Bougatsos, I. Blazina, J. Khangura, B. Zakher.
Critical revision of the article for important intellectual content: R. Chou, I. Blazina, B. Zakher.
Final approval of the article: R. Chou, I. Blazina, J. Khangura.
Statistical expertise: R. Chou.
Obtaining of funding: R. Chou.
Administrative, technical, or logistic support: T. Dana, C. Bougatsos, I. Blazina.
Collection and assembly of data: R. Chou, T. Dana, C. Bougatsos, I. Blazina, J. Khangura
In 2004, the U.S. Preventive Services Task Force (USPSTF) recommended against screening for hepatitis B virus (HBV) infection.
To update the 2004 USPSTF review on screening for HBV infection in adolescents and adults.
MEDLINE (through January 2014), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and PsycINFO.
Randomized trials of screening and treatment and observational studies of screening or the association between intermediate and clinical outcomes after antiviral therapy.
One investigator abstracted data, and a second investigator checked them; 2 investigators independently assessed study quality.
No study directly evaluated the effects of screening for HBV infection versus no screening on clinical outcomes. Vaccination against HBV infection was associated with decreased risk in high-risk populations. On the basis of 11 primarily fair-quality trials, antiviral therapy may be more effective than placebo for reducing the risk for clinical outcomes associated with HBV infection. However, differences were not statistically significant. On the basis of 22 primarily fair-quality trials, antiviral therapy was more effective than placebo for various intermediate outcomes, with limited evidence that first-line antiviral agents are superior to lamivudine. Antiviral therapy was associated with a higher risk for withdrawal due to adverse events than placebo, but risk for serious adverse events did not differ.
Only English-language articles were included, clinical outcome data for antiviral therapies were limited, and several studies were done in countries where the prevalence and natural history of HBV infection differ from those of the United States.
Antiviral treatment for chronic HBV infection is associated with improved intermediate outcomes, but more research is needed to understand the effects of screening and subsequent interventions on clinical outcomes and to identify optimal screening strategies.
Agency for Healthcare Research and Quality.
HBeAg = hepatitis B e antigen; HBV = hepatitis B virus; KQ = key question.
* The full report (12) addresses this KQ.
Summary of evidence search and selection.
* Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews.
† Reference lists of relevant articles.
‡ Some studies are included for >1 key question.
§ The full report (12) addresses this key question.
Table. Characteristics of Studies of Antiviral Therapy
Antiviral therapy versus placebo or no treatment for histologic improvement.
M–H = Mantel–Haenszel.
Antiviral therapy versus placebo or no treatment for HBeAg loss.
HBeAg = hepatitis B e antigen; M–H = Mantel–Haenszel.
* Adefovir, 30 mg, vs. placebo.
† 68-wk data.
Antiviral therapy versus placebo or no treatment for HBV DNA loss.
HBV = hepatitis B virus; M–H = Mantel–Haenszel.
Antiviral therapy versus placebo or no treatment for HBsAg loss.
HBsAg = hepatitis B surface antigen; M–H = Mantel–Haenszel.
Appendix Table 1. Intermediate Outcomes From Head-to-Head Trials*
Head-to-head studies of antiviral therapy for HBV DNA loss.
Antiviral therapy versus placebo or no treatment for incident cirrhosis.
Antiviral therapy versus placebo or no treatment for hepatocellular carcinoma.
Antiviral treatment versus placebo or no treatment for mortality.
Appendix Table 2. Studies of the Association Between Intermediate and Final Health Outcomes
Appendix Table 3. Associations Between Intermediate and Clinical Outcomes
Appendix Table 4. Summary of Evidence
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Chou R, Dana T, Bougatsos C, Blazina I, Khangura J, Zakher B. Screening for Hepatitis B Virus Infection in Adolescents and Adults: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Ann Intern Med. ;161:31–45. doi: 10.7326/M13-2837
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Published: Ann Intern Med. 2014;161(1):31-45.
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Viral Hepatitis.
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