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Beyond Risk Factors: Rethinking Hepatitis B and Hepatitis C Screening in Primary Care.

Elena Vargas-Accarino1,2,3, Ariadna Rando-Segura3,4, María Asunción Úbeda5

  • 1Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.

Liver International : Official Journal of the International Association for the Study of the Liver
|September 19, 2025
PubMed
Summary
This summary is machine-generated.

Current hepatitis B (HBV) and hepatitis C (HCV) screening in primary care misses many cases. Universal screening for all adults is recommended to improve viral hepatitis detection and elimination efforts.

Keywords:
hepatitis Bhepatitis Cprimary carescreening

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Public Health

Background:

  • International guidelines often limit HBV and HCV screening to individuals with risk factors or elevated ALT.
  • This targeted approach may be insufficient for the complete eradication of viral hepatitis.
  • The study assesses the effectiveness of EASL HBV and HCV screening guidelines within primary care settings.

Purpose of the Study:

  • To evaluate the efficacy of current risk factor-based screening for hepatitis B and C in primary care.
  • To determine the proportion of positive cases missed by traditional screening methods.
  • To advocate for universal screening to enhance viral hepatitis elimination strategies.

Main Methods:

  • A dual approach combining retrospective data analysis (January 2021-March 2023) and a prospective intervention (March-April 2024).
  • Retrospective review of microbiology data for testing rates, clinical characteristics, and management.
  • Prospective screening and risk factor surveys for all adult patients attending two primary care centers.

Main Results:

  • Retrospective analysis (90,170 patients) showed low HBV (16%) and HCV (10%) screening rates.
  • A significant proportion of positive HBV (67%) and HCV (54-46%) cases lacked traditional risk factors or elevated ALT.
  • Prospective study (1030 patients) confirmed low detection rates among those with risk factors, with 67% of positive HCV cases lacking indicators.

Conclusions:

  • Risk factor-based screening for HBV and HCV in primary care is suboptimal.
  • A substantial number of individuals with viral hepatitis do not present with identifiable risk factors or elevated ALT.
  • Implementing universal, one-time screening for all adults is proposed as a superior strategy to improve detection and advance viral hepatitis elimination.