Screening for hepatitis B virus infection in nonpregnant adolescents and adults systematic review to update the 2004 U.S. Preventive Services Task Force recommendation
Limited evidence from head-to-head trials found that entecavir and pegylated interferon alfa-2a had greater likelihood of achieving intermediate outcomes than lamivudine. Studies on the association between improvements in intermediate outcomes following antiviral therapy and clinical outcomes were h...
|Main Authors:||, , ,|
Agency for Healthcare Research and Quality
2014, May 2014
|Collection:||National Center for Biotechnology Information - Collection details see MPG.ReNa|
|Summary:||Limited evidence from head-to-head trials found that entecavir and pegylated interferon alfa-2a had greater likelihood of achieving intermediate outcomes than lamivudine. Studies on the association between improvements in intermediate outcomes following antiviral therapy and clinical outcomes were heterogeneous and had methodological limitations, precluding strong conclusions. Antiviral therapy was associated with a higher risk of withdrawal due to adverse events than placebo, but there was no difference in risk of serious adverse events. LIMITATIONS: We included only English-language publications. Studies conducted in countries where the prevalence and natural history of HBV infection differ from those in the United States were included due to limited evidence from settings more applicable to practice in the United States. Evidence from placebo-controlled trials on intermediate and clinical outcomes was limited or not available for some first-line antiviral therapies.|
BACKGROUND: In 2004, the U.S. Preventive Services Task Force (USPSTF) recommended against screening asymptomatic persons in the general population for hepatitis B virus (HBV). PURPOSE: To systematically review the current evidence on the benefits and harms of screening for HBV infection in asymptomatic nonpregnant adolescents and adults. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials (through January 2014), the Cochrane Database of Systematic Reviews (2005 through January 2014), Ovid MEDLINE(r) (1946 through January 2014), and PsycINFO(r) (1806 through January 2014) and reviewed reference lists of relevant articles. STUDY SELECTION: We included randomized trials of screening and treatment that reported intermediate or clinical outcomes. We also included observational studies of screening and on the association between improvement in intermediate outcomes after antiviral therapy and improvement in clinical outcomes.
DATA EXTRACTION: One investigator abstracted data, and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): We found no direct evidence on effects of screening for HBV infection versus no screening on clinical outcomes. HBV vaccination was associated with decreased risk of HBV acquisition in high-risk populations. Data from randomized trials suggest that antiviral therapy may be more effective than placebo for reducing risk of clinical outcomes associated with HBV infection, but differences were not statistically significant and pooled estimates were imprecise due to small numbers of events. Evidence consistently found antiviral therapy to be more effective than placebo or no treatment for various intermediate histological, virological, biochemical, and serological outcomes. Results were generally consistent when analyses were stratified by individual drug.
CONCLUSIONS: Although screening tests can accurately identify adolescents and adults with chronic HBV infection, more research is needed to understand the effects of screening and subsequent interventions on clinical outcomes and to identify optimal screening strategies. The declining incidence and prevalence of HBV infection as a result of universal vaccination programs is likely to impact future assessments of the benefits and harms of HBV screening
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