A 40-year-old man with a new diagnosis of hepatitis B

A 40-year-old man emigrated from India 2 years ago and has no prior medical conditions.He requested a clinic visit with his primary care provider (PCP) now that he is 40 years old.He has not been screened for diabetes or hypercholesterolemia, and his PCP considers what other routine screening should be discussed. What are the current recommendations for hepatitis B virus screening in adult patients?The 2025 Canadian guideline on hepatitis B virus (HBV) recommends that all adults have 1-time triple HBV serology, which includes HB surface antigen (HBsAg), HB surface antibody (HBsAb), and HB core antibody (HBcAb), irrespective of risk or clinical history. 1 Risk-based screening is generally ineffective, especially when related to stigmatized activities such as sex or drug use, 2 and most individuals do not have symptoms. 1The prevalence of HBV infection among the general population in Canada ranges from 0.4% to 1.0%, with estimates among immigrants from countries where HBV infection is common ranging from 1.9% to 5.6%. 3However, routine HBV screening is not part of the Canadian immigration medical examination, 4,5 and as a result, people may live in Canada for decades before a diagnosis.Many individuals may have even been screened for occupational reasons but are screened only for immunity or vaccination status -that is, HBsAb only.This isolated testing can result in individuals incorrectly being identified as "not immune" when they are in fact infected, as infected individuals do not typically make HBsAb.Triple serology ensures a comprehensive understanding of the individual's HBV status (Box 1).The results for this individual are as follows: HBsAg positive, HBcAb positive, HBsAb negative.At a follow-up clinic visit, the PCP informs him of his HBV infection.The patient describes that he was tested for HBsAb for his occupation in the past and was HBsAb negative, and that he received 3 doses of the HBV vaccine but was not tested for HBV infection (i.e., HBsAg). What baseline investigations should be ordered for a new diagnosis of HBV?Box 2 outlines the recommended investigations for a patient with newly diagnosed HBV infection. 1,6The 2025 guideline states that screening for hepatitis D virus (HDV) antibodies should be ordered for all patients positive for HBsAg. 1 Coinfection with HDV accelerates progression to advanced liver disease 7 and can be as high as 40% to 60% in some regions.Countries or regions with a high prevalence of HBV and HDV include Mongolia, Romania, Pakistan, and parts of West and Central Africa. 8,9