[Table, HBV Screening and Diagnosis]. - Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

RECOMMENDATIONS
Screening Tests Clinicians should determine the HBV vaccination and immune status of patients with HIV by performing laboratory testing for HBsAg, anti-HBs, and anti-HBc (total). (A) See Table 1: Interpretation of HBV Screening Test Results. Clinicians should repeat laboratory screening annually in patients who are not immune to HBV, choose not to be vaccinated, and are at ongoing risk of acquiring HBV. (A3) Diagnosis* In patients with positive baseline (screening) HBsAg test results, clinicians should perform HBeAg, anti-HBe, and HBV DNA testing to diagnose the phase of HBV infection. (B2†) See Table 2: Serologic and Virologic Responses to HBV Infection. If a patient with HIV and unknown HBsAg status has signs or symptoms of acute hepatitis (i.e., elevated ALT), the clinician should perform HBsAg, anti-HBc IgM, HBeAg, anti-HBe (A), and HBV DNA (A3) testing along with other diagnostic testing for acute hepatitis. Acute HBV Infection* If acute HBV infection is confirmed and the patient is asymptomatic, the clinician should repeat ALT testing within 2 to 4 weeks to assess for symptoms of liver disease progression (B3) and repeat HBsAg, HBeAg, anti-HBe, and HBV DNA testing 6 months later to determine whether infection has cleared. (A3) If a patient with HIV and acute HBV is not taking ART, the clinician should recommend ART initiation. (A1) Transmission Prevention Clinicians should advise patients who have a positive HBsAg test result that they can transmit HBV (A*) and encourage sexually active patients to use effective barrier protection to reduce the risk of HBV transmission. (A2†) Clinicians should inform patients with HBV that their household contacts should be vaccinated and counsel the patients to avoid sharing items such as razors or toothbrushes that could expose others to HBV-contaminated blood. (A2†) For individuals who inject drugs, clinicians should offer or refer for substance use treatment, ensure access to clean needles and syringes, and provide harm reduction counseling. (A2†) See NYSDOH Drug Use Resources.

RECOMMENDATIONS

Screening Tests

Clinicians should determine the HBV vaccination and immune status of patients with HIV by performing laboratory testing for HBsAg, anti-HBs, and anti-HBc (total). (A*) See Table 1: Interpretation of HBV Screening Test Results.
Clinicians should repeat laboratory screening annually in patients who are not immune to HBV, choose not to be vaccinated, and are at ongoing risk of acquiring HBV. (A3)

Diagnosis

In patients with positive baseline (screening) HBsAg test results, clinicians should perform HBeAg, anti-HBe, and HBV DNA testing to diagnose the phase of HBV infection. (B2†) See Table 2: Serologic and Virologic Responses to HBV Infection.
If a patient with HIV and unknown HBsAg status has signs or symptoms of acute hepatitis (i.e., elevated ALT), the clinician should perform HBsAg, anti-HBc IgM, HBeAg, anti-HBe (A*), and HBV DNA (A3) testing along with other diagnostic testing for acute hepatitis.

Acute HBV Infection

If acute HBV infection is confirmed and the patient is asymptomatic, the clinician should repeat ALT testing within 2 to 4 weeks to assess for symptoms of liver disease progression (B3) and repeat HBsAg, HBeAg, anti-HBe, and HBV DNA testing 6 months later to determine whether infection has cleared. (A3)
If a patient with HIV and acute HBV is not taking ART, the clinician should recommend ART initiation. (A1)

Transmission Prevention

Clinicians should advise patients who have a positive HBsAg test result that they can transmit HBV (A*) and encourage sexually active patients to use effective barrier protection to reduce the risk of HBV transmission. (A2†)
Clinicians should inform patients with HBV that their household contacts should be vaccinated and counsel the patients to avoid sharing items such as razors or toothbrushes that could expose others to HBV-contaminated blood. (A2†)
For individuals who inject drugs, clinicians should offer or refer for substance use treatment, ensure access to clean needles and syringes, and provide harm reduction counseling. (A2†)
- See NYSDOH Drug Use Resources.

From: Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

Cover of Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

Prevention and Management of Hepatitis B Virus Infection in Adults With HIV [Internet].

Gupta A, Fine SM, Vail RM, et al.

Baltimore (MD): Johns Hopkins University; 2022 Aug.

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