High-risk groups should be tested for HBV infection. These include immigrants/refugees from areas of intermediate or high endemicity, persons with chronically elevated aminotransferases, immunocompromised individuals, and persons with a history of injection drug use(IDU).^[1] Additionally, screening for hepatocellular carcinoma should extend to any HBV carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL.^[2]

The following groups should be tested for HBV infection:^[1]

• Persons born in high or intermediate endemic areas
• United States–born people who were not vaccinated as infants and whose parents were born in regions with high HBV endemicity
• Persons with chronically elevated aminotransferases
• Persons who require immunosuppressive therapy
• Men who have sex with men
• People with multiple sexual partners or history of sexually transmitted disease
• Incarcerated people
• Persons who have ever used injecting drugs, dialysis patients, HIV– or HCV-infected individuals, pregnant women, and family members, household members, and sexual contacts of HBV-infected people
• Testing for HBsAg and anti-HBs should be performed, and seronegative persons should be vaccinated. (Grade I Recommendation)

The following groups should be screened with US examination every 6-12 months: (Grade II-2)^[2]

• HBV carriers at high risk for HCC such as Asian men over 40 years and Asian women over 50 years of age
• People with cirrhosis
• People with a family history of HCC
• Individuals of African descent over 20 years of age
• Any carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL

For HBV carriers at high risk for HCC who are living in areas where US is not readily available, periodic screening with AFP should be considered. (Grade II-2)