Prevalence of hepatitis B surface antigen and hepatitis B core antibody in a population initiating immunosuppressive therapy.

Abstract

9009 Background: Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication after immunosuppressive therapy and can lead to significant morbidity and mortality. We previously identified 22 HBV reactivations in patients of various nationalities without association with a particular malignancy or medication. Our institution subsequently initiated a standard to screen patients initiating immunosuppressive therapy (chemotherapy and/or corticosteroids) for HBV. We report the prevalence of HBV surface antigen (HBsAg) and HBV core antibody (HBcAb) positivity in the first 6 months of this screening program. Methods: We conducted a prospective quality assurance study of all patients at Memorial Sloan-Kettering Cancer Center who were started on immunosuppressive therapy and screened for HBV from June to December 2009. Screening consisted of serologies for HBsAg and HBcAb. If either test was positive, HBV PCR was measured. Results: During the first 6 months of our screening program (June 18- December 18 2009), 3,343 patients (median age 58, 44% male) were screened for HBV prior to initiation of immunosuppression. Conclusions: In the first 6 months of a routine testing program to detect markers of HBV infection, we found a prevalence of 1.3% for HBsAg and 9% for HBcAb. Only half of those with evidence of HBV surface antigen were from regions endemic for HBV. Our findings demonstrate that risk-group-based screening misses many patients who are at risk for reactivation. We therefore recommend other cancer centers implement a similar universal screening program. Total + Median age (years) Male (%) Born in Asia (%) Detectable PCR HBsAg- HBcAb+ 285 (9%) 61 51 20 7 (2.5%) HBsAg+ HBcAb+ 44 (1.3%) 56 70 52 32 (73%) No significant financial relationships to disclose.