Fatma ÇÖLKESEN, Seda YILMAZ, Mustafa DURAN

Evaluation of the clinical practices and awareness of hematologists related to hepatitis B reactivation

Aim: This study aimed to evaluate the awareness and knowledge of hematologists about hepatitis B virus reactivation (HBVr) to draw attention to this subject’s importance. Material and Methods: Sixty-six hematologists included in Turkey. A 13-item questionnaire was administered to the study group to evaluate awareness, knowledge, and experience of HBVr. Results: It was thought by 97% of the participants that all patients who were to receive immunosuppressive treatment (IST) should be screened in respect of HBV. While 98.5% of the hematologists thought HBsAg should be examined in the screening, 89.4% thought anti-HBcIgG should be examined. A total of 89.4% of the hematologists stated that prophylaxis should be started before IST. HBV prophylaxis had been previously administered to patients receiving IST by 97% of the hematologists, and 44% had encountered HBVr at least once in patients. Training related to HBVr after IST had been received following graduation by 75.8% of the hematologists. Conclusions: Awareness about HBVr was found to be high in the hematologists in this study. However, it is worrying that there are clinicians not using anti-HBcIgG test in screening, and the screening rate before treatment with tyrosine kinase inhibitors was low. There was seen to be no standard follow-up protocol either for patients who had started or had not started prophylaxis. This study can be considered to be a stimulus on the subjects of preventing patients with isolated anti-HBcIgG positivity being overlooked, determining the HBVr risk associated with IST, and optimizing the follow-up of patients.

PDF

___

1. Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virüs infection. MMWR Recomm Rep. 2008;57(RR-8): 1-20.
2. Bessone F, Dirchwolf M. Management of hepatitis B reactivation in immunosuppressed patients: An update on current recommendations. World J Hepatol. 2016;8:385-94.
3. Reynolds JA, Manch RA, Gish RG. Medical interventions associated with HBV reactivation: Common and less common. Clin Liver Dis. 2015;5:32– 4.
4. European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virüs infection. J Hepatol. 2012;57:167-85.
5. Lubel JS, Angus PW. Hepatitis B reactivation in patients receiving cytotoxic chemotherapy: diagnosis and management. J Gastroenterol Hepatol. 2010;25(5):864-71.
6. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009;49:156–65.
7. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association institute technical review on prevention and treatment of hepatitis B virüs reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:221–44.
8. Sarin SK, Kumar M, Lau GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1–98.
9. Wu T, Kwok RM, Tran TT. Isolated anti-HBc: The Relevance of Hepatitis B Core Antibody-A Review of New Issues. Am J Gastroenterol. 2017;112(12):1780-8.
10. Lee RS, Bell CM, Singh JM, et al. Hepatitis B screening before chemotherapy: a survey of practitioners’ knowledge, beliefs, and screening practices. J Oncol Pract. 2012;8(6), 325-8.
11. Tran TT, Rakoski MO, Martin P, et al. Screening for hepatitis B in chemotherapy patients: survey of current oncology practices. Aliment Pharmacol Ther. 2010;31(2),240-6.
12. Day FL, Link E, Thursky K, et al. Current hepatitis B screening practices and clinical experience of reactivation in patients undergoing chemotherapy for solid tumors: a nationwide survey of medical oncologists. J Oncol Pract. 2011;7(3): 141-7.
13. Khokhar OS, Farhadi A, McGrail L, et al. Oncologists and hepatitis B: a survey to determine current level of awareness and practice of antiviral prophylaxis to prevent reactivation. Chemotherapy. 2009;55(2):69-75.
14. Stine JG, Khokhar OS, Charalambopoulos J, et al. Rheumatologists’ awareness of and screening practices for hepatitis B virüs infection prior to initiating immunomodulatory therapy. Arthritis Care Res. (Hoboken) 2010;62(5): 704-11.
15. Marignani M, Marzano A, Begini P, et al. Perception of hepatitis B virüs infection reactivation-related issues among specialists managing hematologic malignancies: result of an Italian survey. Leuk Lymphoma. 2014;55(11):2564-71.
16. Varma A, Biritxinaga L, Saliba RM, et al. Impact of hepatitis B core antibody seropositivity on the outcome of autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant. 2017;23(4):581-7.
17. Lok AS, Liang RH, Chiu EK, al. Reactivation of hepatitis B virüs replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology. 1991;100(1):182-8.
18. Köksal ˙I. Immunosuppressive therapy and hepatitis b virüs reactivation. Viral Hepat J. 2016;22:69-73.
19. Reddy KR, Beavers KL, Hammond SP, et al; American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virüs reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215-9.
20. Terrault NA, Bzowej NH, Chang KM, et al; American Association for the Study of Liver Diseases. AASLD Guidelines forTreatment of Chronic Hepatitis B. Hepatology. 2016;63:261-83.
21. McNamara C, Davies J, Dyer M, et al. Guidelines on the investigation and management of follicular lymphoma. Br J Haematol. 2012;156(4):446-67.
22. Lee RS, Bell CM, Singh JM, et al. Hepatitis B screening before chemotherapy: a survey of practitioners’ knowledge, beliefs, and screening practices. J Oncol Pract. 2012;8(6),325-8.
23. Turker K, Oksuzoglu B, Balci E, et al. Awareness of hepatitis B virus reactivation among physicians authorized to prescribe chemotherapy. Eur J Intern Med. 2013;24(8),e90-e92.
24. Wang B, Mufti G, Agarwal K. Reactivation of hepatitis B virus infection in patients with hematologic disorders. Haematologica. 2019;104(3),435-43.
25. Pattullo V. Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure. World J Hepatol. 2015;7:954–67.
26. Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219–37.
27. Idilman R. Lamivudine prophylaxis in HBV carriers with haematooncological malignancies who receive chemotherapy. J Antimicrob Chemother. 2005;55:828-31.