1Division of Gastroenterology and Hepatology, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA, 02114, USA. firstname.lastname@example.org.
2Department of Gastroenterology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL, 23309, USA.
3Department of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA, 02111, USA.
4Tufts University School of Medicine, 145 Harrison Street, Boston, MA, 02111, USA.
5Division of Gastroenterology and Hepatology, Virginia Commonwealth University Medical Center, 1101 East Marshall Street, Richmond, VA, 23298-0663, USA.
BACKGROUND AND AIMS:
Hepatitis B reactivation in patients undergoing immunosuppressive therapy can lead to liver failure and death. Prior studies have shown suboptimal hepatitis B screening rates, but few have compared screening rates across specialties or factors associated with screening.
A retrospective study was performed using a hospital-based chemotherapy database and outpatient pharmacy records from January 1999 to December 2013. HBV screening rates prior to initiation of immunosuppression were determined. Multivariate analysis was used to determine predictors of HBV screening.
Of the 4008 study patients, 47 % were screened prior to receiving immunosuppressive therapy; only 48 % on rituximab and 45 % of those on anti-TNF therapy were screened. Transplant specialists screened most frequently (85 %) while gastroenterologists screened the least (34 %). Factors significantly associated with HBV screening were younger age, Asian race, use of anti-rejection therapy, and treatment by a transplant specialist (p < 0.001).
HBV screening prior to immunosuppressive therapy is suboptimal, especially among gastroenterologists. Efforts to improve screening rates in at risk populations are needed.