Most Americans with chronic hepatitis B aren’t discovered through routine screening but rather when they’re already being treated for other liver problems, revealing a critical gap in our current healthcare practices.
At a Glance
- An alarming 81.4% of privately insured Americans with chronic hepatitis B remain undiagnosed
- Between 580,000 and 2.4 million people in the U.S. live with hepatitis B virus, with two-thirds unaware of their infection
- The CDC now recommends at least one lifetime screening for all adults aged 18 and older
- Only 34.79% of hepatitis B patients with cirrhosis and 48.64% with liver cancer receive antiviral therapy
The Silent Epidemic
Chronic hepatitis B virus (HBV) infection affects approximately 300 million people worldwide and remains a major cause of liver failure, cirrhosis, and liver cancer. In the United States alone, between 800,000 and 1.4 million people are living with chronic HBV infection, resulting in 2,000 to 4,000 deaths annually. Despite these concerning numbers, a recent investigation highlighted in Medscape Medical News reveals that most chronic hepatitis B diagnoses in the U.S. occur indirectly when patients are being evaluated for other liver conditions, not through proactive screening efforts.
The findings underscore a troubling reality: only 18.6% of privately insured patients with chronic hepatitis B have been diagnosed. This means more than four out of five infected individuals remain unaware of their condition, missing opportunities for early intervention that could prevent serious liver damage. The current approach to hepatitis B screening appears inadequate, particularly considering that effective antiviral treatments are available for those diagnosed early enough.
CDC’s Updated Screening Recommendations
In response to the significant gaps in diagnosis, the Centers for Disease Control and Prevention (CDC) has updated its recommendations for hepatitis B screening in the United States. The new guidelines advocate for at least one lifetime screening for all adults aged 18 years and older, using three laboratory tests to effectively identify chronic infections. This universal screening approach represents a shift from the previous risk-based screening strategy, which clearly missed many cases.
Studies show that universal screening is not only more effective at identifying cases but is also more cost-effective than risk-based screening. The CDC has set an ambitious goal to increase awareness of HBV infection from the current 32% to 90% by 2030, aligning with the World Health Organization’s viral hepatitis elimination goals. This represents a significant challenge, but one that public health officials consider essential to reducing the burden of this preventable disease.
Barriers to Effective Care
Even when patients are diagnosed with chronic hepatitis B, treatment rates remain distressingly low. Research shows that only 34.79% of patients with cirrhosis and 48.64% with hepatocellular carcinoma (liver cancer) receive appropriate antiviral therapy. These treatment gaps are particularly concerning since these patients have already developed serious complications that could potentially have been prevented with earlier intervention.
Multiple barriers contribute to these care gaps, including cultural stigma, lack of knowledge about the disease, financial concerns, and healthcare provider unfamiliarity with chronic hepatitis B guidelines. Additionally, disparities in diagnosis and treatment have been observed across racial, ethnic, and gender lines, with minorities and women less likely to receive timely treatment. Insurance type and out-of-pocket expenses also play significant roles in determining who receives appropriate care.
Moving Toward Solutions
Addressing the chronic hepatitis B diagnosis and treatment gap requires a multifaceted approach. The CDC’s shift to universal screening represents an important first step, but implementation will require healthcare systems to incorporate screening into routine care. Serologic testing for hepatitis B surface antigen (HBsAg) remains the primary method for identifying chronic HBV infection and should become a standard part of adult healthcare.
Collaborative efforts from healthcare institutions, governments, and industry are needed to tackle chronic hepatitis B effectively. Improving connection to care after diagnosis is essential, as is reducing financial barriers to treatment. Healthcare provider education must also be enhanced to ensure clinicians are familiar with the latest screening and treatment guidelines. With concerted effort, the U.S. can work toward the Department of Health and Human Services’ goal of reducing hepatitis B mortality to 0.16 cases per 100,000 people by 2030.
