HBV Screening Research Articles

Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study.

IntroductionThe prevalence of HIV, hepatitis B, and hepatitis C amongst migrants in France is high. Thus, effective screening and follow-up is needed. The mandatory medical check-up for residency application is an opportunity to offer rapid HIV and hepatitis testing. The main objective of the STRADA study is to create a feasible and acceptable screening strategy for migrants. Within the STRADA study, this qualitative research examined the acceptability of conducting screening tests in the context of residency application.MethodsWe conducted a qualitative study amongst legal migrants over 18 years of age with sufficient knowledge of the French, English, or Arabic language. Interviews were performed following a semi-structured interview guide of open-ended questions. Interviews were transcribed verbatim and subsequently analyzed through thematic analysis.ResultsWe interviewed 34 migrants. Mean age was 32.6 (min-max: 19, 59) years. The participants’ region of origin was mostly Sub-Saharan Africa and the main reason for migrating to France was family reunification. Migrants' acceptability of HIV and hepatitis testing was high. Participants who accepted testing indicated a benefit for individual health and to avoid transmission. Most preferred rapid tests; reluctance was related to anxiety about the immediate results and the perceived reliability of rapid tests. Migrants' knowledge about HIV was satisfactory, but inadequate for hepatitis. Screening in the context of a compulsory medical visit did not present an obstacle for acceptability. Some expressed concern in the case of HIV but when explained, the independence between obtaining the residence permit along with screening and access to medical care was well understood.DiscussionMedical check-ups at immigration centers is an opportunity to screen for HIV and hepatitis which is considered acceptable by migrants. Informing migrants that test results do not affect residency applications, and incorporating their preferences, are all important to optimize the acceptability of screening.

Abstract B002: Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees

Abstract Background: Hepatitis B (HBV), a leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the United States. Undiagnosed HBV infection precludes HCC screening and contributes to late-stage presentation and decreased survival. Previously, we reported low HBV screening rates in persons from endemic countries. Barriers to screening include lack of insurance, limited diffusion of guidelines, and provider uncertainty. We aimed to assess knowledge about HBV and HCC screening and to explore barriers to HCC screening among trainees from three unique institutions. Methods: We administered a survey to trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We used univariate, bivariate, and Pearson's chi-squared analyses to assess knowledge and barriers using clinical vignettes. Results: There were 183 respondents born in 36 countries. Median age was 31 years. The sample was 35% Hispanic, 29% White, 18% Asian, 9% Black, 7% other, 2% multiracial and 52% male. Training department was Internal Medicine, 71%, Family Medicine, 11%, Infectious Diseases (ID), 6%, or Gastroenterology (GI), 7%. The perceived burden of HBV was low; 2/3 stated HBV affects <5% of the patient population, 59% correctly estimated national HBV prevalence and 25% correctly estimated global prevalence. In vignettes with behavioral risk factors (e.g., intravenous drug use), trainees correctly advised screening, 63-96%. However, when birthplace was the only risk factor, correct responses ranged from 33-53%. Overall, 48% chose an incorrect combination of HBV screening tests. Respondents from HBV-endemic countries were no more likely to screen for HBV. Knowledge of HBV treatment indications was poor. More fellows (ID/GI) correctly recommended treatment than residents, p <0.01. Barriers to HBV screening were lack of education among health care workers, limited expertise in screening of immigrants, and limited patient education. Barriers to treatment were cost, knowledge about HBV regimens, and provider comfort. Respondents were more likely to recommend HCC screening in cirrhotic patients vs. noncirrhotic HBV patients, even when indicated. Only 43% of participants recognized that HCC screening is unnecessary in patients with acute HBV and 53% either recommended HCC screening or indicated uncertainty in noncirrhotic patients with resolved HBV infection. Respondents indicated they would screen for HCC if strong evidence suggested a mortality benefit or if recommended by a national organization. Key barriers to screening were uncertainty or lack of awareness about HCC guidelines and patient financial barriers. Conclusions: In a diverse sample of trainees, knowledge of HBV and HCC screening recommendations is suboptimal. Efforts to broadly disseminate guidelines through targeted educational interventions are needed as responses confirm that HCC screening indications, especially in HBV, are not universally known. Citation Format: Patricia D. Jones, Mahmoud Mahfouz, Harry Nguyen, Jonathan Tu, Carlos R. Diaz, Shweta Anjan, Stefanie Brown, Kassandra Bosire, Paul M. Martin, Olveen Carrasquillo. Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B002.

Routine Investigations in the Antenatal Booking Visit: An Epidemiological Survey

Abstract Background: The antenatal care investigations is very important to determine the antenatal care problems, manage these problems and decrease the maternal morbidity and mortality. Aim of Study: Is to identify the medical pattern in the egyptian pregnant women from Kafr El-Sheikh according to the results of the booking test. Patients and Methods: Cross sectional study was done over 1260 pregnant women from 2015 to 2017 from the outpatient clinic of Obstetrics and Gynecology in Kafr El-Sheikh General Hospital, out of them 260 pregnant women stepped out of the study, all the pregnant women was asked to do the following antenatal care laboratory investigations, complete blood count, random blood sugar, Rh typing, cy-tomegalovirus (CMV) IgG antibodies, hepatitis B virus surface antigen, hepatitis C virus antibodies, high vaginal swap for bacterial vaginosis, urine analysis, all the data gathered for each woman in a file with her name for the statistical analysis. Results: Percentage of anemia was 47.1% with negative significant correlation with age, percentage of DM was 8.1%, percentage of Rh negative was 12.6%, percentage of CMV IgG was 85.7%, percentage of HBV was 2.4%, percentage of HCV was 7.9% with positive significant correlation with history of previous CS, percentage of bacterial vaginosis was 27% and percentage of UTI was 62%. Conclusion: A lot of women in Kafr El-Sheikh do not know the importance of the antenatal investigations and the control of the antenatal problems. Recommendations: There is need for give more concern about routine antenatal care investigations and it's importance and routine screening for anemia, DM, Rh, CMV, HBV, HCV, BV and UTI.

Online versus in-person training of community health workers to enhance hepatitis B virus screening among Korean Americans: Evaluating cost & outcomes.

From 2014 to 2018, we developed and implemented culturally appropriate interventions delivered by community health workers (CHWs) in Pennsylvania and New Jersey. To determine the most cost-effective approach, we recruited 40 predominantly foreign-born Korean American CHWs and used cluster sampling to assign them into two training groups (online training vs. in-person training). We prospectively assessed the cost of training 40 Korean American CHWs and the cost of subsequent HBV educational workshops delivered by the CHWs. We also assessed these costs relative to the success of each training approach in recruiting participants for HBV screening and vaccination. We found that the training costs per participant were higher for in-person training ($1.71 versus $1.12), while workshop costs per participant were lower for in-person training ($2.19 versus $4.22). Workshop attendee costs were comparable. After accounting for site clustering, there were no significant differences in total costs per participant ($24.55 for the online-trained group and $26.05 for the in-person group). In-person trained CHWs were able to generate higher HBV screening and vaccination rates (49.3% versus 21.4% and 17.0% versus 5.9%, respectively) among their participants compared with online-trained CHWs. Given better outcomes and no differences in costs, in-person training dominated the online training option. Despite the potential for efficiency to be gained with online training, CHWs who attended live training outperformed their online-trained colleagues. Elements of the didactic approach or practice with peers in the live session may have contributed to the superior training effectiveness and, ultimately, improved cost-effectiveness of the in-person approach.

Knowledge, risk of infection, and vaccination status of hepatitis B virus among rural high school students in Nanumba North and South Districts of Ghana.

Hepatitis B (HB) is a viral infection that affects the liver and can lead to life-threatening conditions including cirrhosis and liver cancer. Over a billion people are estimated to be infected globally with the hepatitis B virus, with over 240 million chronically infected. Sub-Saharan Africa including Ghana is an HBV endemic area and an estimated 5%- 10% of the population in the region is infected. Research on the knowledge and vaccination status of hepatitis B in rural communities in Ghana is lacking. The objectives of this study proposed were to assess the HBV knowledge, risk of HBV infection, and vaccination status of high school students in two rural districts of the Northern region on Ghana. A cross-sectional study of a random sample of 426 students from two senior high schools in the Nanumba North and South districts of the Northern region of Ghana on hepatitis B knowledge and vaccination status was conducted. Descriptive statistics were used to analyze and present data on demographic and knowledge variables. A Mann Whitney U test was used to compare the differences in HBV knowledge between male and female students and between students of the two high schools that were involved in the study. Pearson correlation coefficient was used to compute the association between HBV knowledge and age of students. Logistic regression was used to develop a model to predict variables that influenced vaccination against HB. The results of the study showed basic but not a good knowledge of HBV among the rural high school students, with a mean score of 11.8 (SD = 1.98) out of a maximum score of 16. Descriptive statistics also revealed that only 20% of 426 students ever tested for HBV and 96 (22.5%) were vaccinated against HBV. A Mann-Whitney U test results revealed no statistically significant difference in HBV knowledge between male and female students (p = 0.688, two-tailed) and between the two high schools (p = 0.24, two-tailed). A Pearson correlation showed no relationship between age and HBV knowledge (p = 0.486). Regression analysis showed that only taking the HBV test (p <0.05) and attending Bimbilla Senior High (p = 0.032) significantly predicted vaccination against HBV infection. The results of this study has re-echoed the high prevalence of HBV in Ghana. The poor state of knowledge and a high risk of HBV infection among young adults in rural communities have also been highlighted in the findings of this study. Vaccination against the HBV infection was found to be low and consistent with other findings. Finally, HBV screening is shown to be significantly associated with vaccination against the virus, hence the need for national screening and vaccination programs.

Barriers to Hepatitis B Screening and Prevention for African Immigrant Populations in the United States: A Qualitative Study.

Chronic hepatitis B infection (HBV) disproportionately affects African Immigrant (AI) communities in the U.S., with a reported infection rate of 15%. HBV screening rates within these communities are low. This study sought to better understand the socio-cultural determinants associated with low HBV screening among AI communities and identify potential strategies to help inform the development of effective HBV education and screening interventions. Seventeen in-depth interviews were conducted with community health experts working in AI communities throughout the U.S. Interviews explored the potential impact of culture, perception of health, awareness of HBV, religious practices, current screening practice, provider relationship, and behaviors towards general prevention. Interview data were analyzed using thematic analysis. Religious preferences and cultural norms affect health care access, perceptions towards prevention, awareness of HBV, and contribute to myths and stigma within this population. Participants reported a lack of HBV knowledge and awareness and barriers to health care access including, cost, language, racism, understanding of Western Medicine, and usage of traditional medicine. This study elucidates the role of religious and cultural beliefs as barriers to HBV screening and care. Results can contribute to public health efforts to increase awareness, screening and vaccination efforts within AI communities.

Where Is the Genesis of Pancreatic Cancer? What is the Cause &amp; Is There a Cure?

We present a case of hepatitis B reactivation in a patient receiving adjuvant chemotherapy for early breast cancer. This is a 49-year-old post-menopausal, Chinese female with history of chronic hepatitis B with inactive carrier state, and right invasive ductal carcinoma staged as cT2N1M0, pT2N1aM0, anatomic stage IIB, prognostic stage IIA, estrogen and progesterone receptor positive, and human epidermal growth factor 2 negative. The patient underwent bilateral mastectomy with implant reconstruction and right axillary lymph node dissection followed by adjuvant chemotherapy planned as dose dense doxorubicin and cyclophosphamide (ddAC), followed by dose dense paclitaxel (ddT). Two weeks after her first cycle of dose dense paclitaxel, she developed grade III HBV reactivation with hepatitis. This report highlights HBV reactivation as a potential complication of chemotherapy for solid tumors, and reviews recommended HBV screening, prevention and management of HBV reactivation in this patient population.

An electronic alert system increases screening for hepatitis B and C and improves management of patients with haematological disorders

Treatment of haematological disorders in patients with chronic hepatitis B or resolved infection (anti-HBc-positive) is associated with a risk of hepatitis B reactivation. Moreover, patients with chronic hepatitis C have a higher risk of haematological malignancies than general population. An electronic alert system was developed to promote screening of hepatitis B (HBV) and C (HCV) in patients starting haematological therapies. The system included screening and linkage to care and a request for testing in those without data. From March, 2017 to March, 2018 data from 420 consecutive patients with haematological diseases were included. At first prescription before the alerts, the HCV and HBV screening rate was 60.5%. Following the alerts, an additional 115 were screened, increasing the overall screening rate to 87.9%. Anti-HBc alone was detected in 57, anti-HCV in 13, and HBsAg in 2 patients. Overall, 68% of patients with any viral hepatitis markers were previously not know, and the impact was particularly important for anti-HBc detection (47/57 unknown). Nucleoside analogues were prescribed in 28 (49.1%) anti-HBc-positive and the 2 HBsAg-positive patients. Prospective follow-up with HBV DNA and HBsAg testing showed no cases of HBV reactivation. An estimated 1.2 HBV reactivations were avoided as consequence of the alert system. In summary, an electronic alert system increased viral hepatitis screening in patients receiving haematological treatment and led to improvements in the management of these patients, including avoided HBV reactivation.

Cost-effectiveness of couple-based immunization strategy to prevent mother-to-child transmission of hepatitis B virus in China: A decision-analytic Markov model

BackgroundMother-to-child transmission (MTCT) is the major route of HBV transmission in many parts of the world. We designed couple-based immunization strategy and aimed to assess the cost-effectiveness of this strategy in China. MethodsWe constructed a decision-analytic Markov model to compared current immunization strategy consisting of hepatitis B vaccination (HepB) for all infants and extra hepatitis B immunoglobulin for infants with HBsAg-positive mothers versus couple-based immunization strategy including additional HBV screening for pre-pregnant couples and HepB for high-risk wives. Costs were assessed from a healthcare system perspective. Number of infants with perinatal HBV infection, life-years (LYs), quality-adjusted life-years (QALYs), and disability-adjusted life-years (DALYs) were used to access effects. We calculated incremental cost-effectiveness ratios (ICERs) and performed sensitivity analysis. FindingsBased on the birth cohort of 17,578,815 livebirths in China in 2017, couple-based immunization strategy reduced perinatal HBV infection by 18% (9194/51,365) with cost increase of ¥ 41 million, saved 49,986 LYs (ICER: ¥819 per LY saved), gained 48,879 QALYs (ICER: ¥837 per QALY gained) and averted 63,362 DALYs (¥646 per DALY averted) compared with current immunization strategy. These ICERs were below willingness-to-pay levels of China's once GDP per capita (¥59,660), remaining robust in sensitivity analysis. InterpretationUnder the intermediate endemic of HBV infection in China, implementation of couple-based immunization strategy can improve the efficiency of preventing MTCT of HBV, and is highly cost-effective. This strategy can be a new immunization strategy choice to achieve the target of eliminating hepatitis B by 2030. FundingNational Natural Science Foundation of China.

Hepatitis B Reactivation: A Potentially Serious Complication of Chemotherapy for Solid Tumors

We present a case of hepatitis B reactivation in a patient receiving adjuvant chemotherapy for early breast cancer. This is a 49-year-old post-menopausal, Chinese female with history of chronic hepatitis B with inactive carrier state, and right invasive ductal carcinoma staged as cT2N1M0, pT2N1aM0, anatomic stage IIB, prognostic stage IIA, estrogen and progesterone receptor positive, and human epidermal growth factor 2 negative. The patient underwent bilateral mastectomy with implant reconstruction and right axillary lymph node dissection followed by adjuvant chemotherapy planned as dose dense doxorubicin and cyclophosphamide (ddAC), followed by dose dense paclitaxel (ddT). Two weeks after her first cycle of dose dense paclitaxel, she developed grade III HBV reactivation with hepatitis. This report highlights HBV reactivation as a potential complication of chemotherapy for solid tumors, and reviews recommended HBV screening, prevention and management of HBV reactivation in this patient population.

Postulating a positive predictive value for HIV, HBV, and HCV screening tests using electrochemiluminescent assay by comparing with ID-NAT results

Background: In India, blood units reactive by the initial screening assays are discarded. A significant number of these are falsely positive, leading to wastage of precious blood. Also of importance is the dilemma created when it comes to donor disclosure. Hence, it is important to evaluate the positive predictive value (PPV) of the initial screening assay to identify false-positive screening results and implement a more balanced algorithm for donor disclosure and counseling. The study was undertaken with an objective of comparing signal-to-cutoff ratio (S/Co) of positive results in HBV, HCV, and HIV screening of electrochemiluminescent (ECI) assay with the results of ID-NAT so as to predict a S/Co ratio of indicative of true positives. Methods: The retrospective study was conducted in the transfusion-transmissible infection Laboratory in a Regional Blood Transfusion Centre in South India. Consecutive blood donors from January 2015 to December 2019 were evaluated simultaneously for HBV, HCV, and HIV by ECI (Vitros 3600, Ortho Clinical Diagnostics) and ID-NAT (Procleix Panther System by Grifols), and the positive results either by one or both were analyzed. Results: A total of 163,596 voluntary donor samples were evaluated. In case of HBV, a S/Co ratio of 1000 predicts a true positive more than 94% of the time. In case of HCV, a S/Co ratio of 8 predicts a true positive more than 95% of the time. Finally, a S/Co ratio of 30 predicts a true positive as well as true negative 100% of the time in case of HIV. Conclusions: It is challenging to propose a standard S/Co ratio because the performance of each assay varies across laboratories. However, the study throws light on the role of the S/Co ratio in reducing the perplexity during donor notification.

Low Level of Hepatitis B Surface Antigen Screening in a Tertiary Health Facility in Nigeria 2000-2014: Imperative for Provider Initiated Testing and Counselling for Hepatitis B Virus?

Introduction: Viral hepatitis is a major public health challenge that requires an urgent response. Reducing mortality requires major scale-up in prevention, testing and treatment access; coverage in HBV vaccination, testing and treatment is low and must accelerate massively to achieve the 2030 targets. Less than 1% of HBV-infected individuals are diagnosed in Sub-Sahara Africa, despite the availability of rapid tests with good diagnostic accuracy. Materials and Methods: This was retrospective cross sectional study conducted in Federal Teaching Hospital Gombe, in North East Nigeria. All children and adults who presented to the out-patient departments, and those that were admitted irrespective of their HIV and or Hepatitis C virus status and had Hepatitis B and/or Hepatitis B envelope antigen test were conducted between 2000 to 2015. All children and adults were tested using the Hospital standard for Hepatitis B surface antigen test strip. Results: Between 2000 and 2014, 739,456 children and adults were admitted and reviewed in the outpatient units of the Federal Teaching Hospital Gombe; there were 685,552 adults and 53,904 children. Children constituted 7.3% (53,904/739,456) of admissions and outpatient consultations. 2.8% (210/7570), 3.3% (773/23,783), 3.6% (1145/32,142), 5.2% (1694/33,043), 3.3% (986/29,216), 1.9% (661/3321), 0.1% (53/41,626), 0.2% (113/46,634), 2.6% (1418/54,423), 5.4% (3717/69,696), 3.7% (2332/62,086), 3.5% (3241/90,623), 3.2% (2881/89,398), 3.8% (2428/62,687), 2.8% (1835/63,208) of children and adults were tested for HBsAg in 2000, 2001, 20002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013 and 2014 respectively. 23,487 children and adults were tested for HBsAg with a cumulative testing rate of 3%. Overall 4465/23,487 children and adults were seropositive for HBsAg giving a cumulative prevalence of 19%. Conclusion: HBV screening in our health facility is very low. Massive scale up in awareness and HBV vaccination are required. Provider initiated testing and counseling for HBV in health facilities needs support for implementation in Health Facilities in Sub Saharan Africa.

FREQUENCY OF HEPATITIS B VIRUS AND HEPATITIS C VIRUS IN PATIENTS UNDERGOING VARIOUS DENTAL PROCEDURES

Objective: To determine the frequency of hepatitis B virus and hepatitis C virus in patients undergoing various dental procedures at Tokyo Yaesu Dental Clinic and Tokyo Dental College Japan. Materials &amp; Methods: In this descriptive study, we determined the frequency of HBV and HCV by screening the patients for HBs antigen and HCV antibody in blood serum before going for any dental procedures. Data were recorded from December 1999 to 2009(9 years &amp; 8 months) in the Tokyo Yaesu Dental Clinic whereas in Tokyo Dental College Japan from October 2006 up to May 2008 (1 year and 8 months).&#x0D; Results: In this study, we assessed 2,181 patients for HBs, out of which 13 (0.60%) cases were found positive for HBs at Tokyo Yaesu Dental Clinic, and out of 3216 patients 33 (1.02%) patients were found positive for HBs antigen at Tokyo Dental College. On another hand 31 (1.42%) patients out of 2181 were found positive of HCV antibody at Tokyo Yaesu Dental Clinic and 45 numbers of cases (1.43%) were found positive for HCV antibody at Tokyo Dental College. Most of the patients were found to be in the 6th and 7th decade of life.&#x0D; Conclusion: Screening for HBV and HCV should be mandatory for every patient going through any invasive and non- invasive dental procedures. Furthermore, sterilizations and standard precautionary protocols must also be observed at Dental clinics and hospitals.&#x0D;

Hepatitis B virus seromarkers among HIV infected adults on ART: An unmet need for HBV screening in eastern Ethiopia.

Progression of chronic HBV to cirrhosis, end-stage liver disease (ESLD), and hepatocellular carcinoma (HCC) is more rapid in HIV positive individuals than those with HBV alone; however, the distribution of HBV seromarkers in HIV infected individuals on antiretroviral therapy (ART) is not well described. To address this problem, we assessed the distribution of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) among HIV infected adults on ART in Eastern Ethiopia. A cross-sectional study was conducted from September 2017 to February 2018. Socio-demographic, behavioral and health related factors, and clinical data were collected using questionnaire and checklist. Plasma samples were tested for HBsAg, anti-HBc and anti-HBs seromarkers using ELISA. Data were double entered into EpiData 3.1, cleaned, exported to and analyzed using STATA 13. Descriptive and logistic regression analysis were conducted and statistical significance was decided at p≤0.05. A total of 901 participants were included and the prevalence of HBsAg was found to be 11.7% [95%CI (10, 14)]. Among the co-infected, 47.6% were also positive for anti-HBc, of which 58% were on an ART containing tenofovir (TDF). Among those screened for the three seromarkers, 38.1% were negative for all and 21% were positive only for anti-HBc (IAHBc). Being single, history of genital discharge and taking ART with TDF combination were significantly associated with HBV co-infection (p≤0.05). There is high burden HBV co-infection among individuals on ART. The unmet need of HBV screening prior to ART initiation leaves many co-infected individuals without appropriate management including therapy, close monitoring or vaccination when indicated, impacting disease prevention.

Is Hepatitis B Surface Antigen (HB s Ag) Enough Alone as a Screening Test for HBV Infection in Rheumatic Disease Patients Before Starting Immunosuppressive Therapies? A Cross-sectional Study.

Prevalence of hepatitis B virus in patients with rheumatic diseases has been reported differently among studies. The loss of immune control in these patients may result in the reactivation of HBV replication within hepatocytes. Considering the lifelong use of multiple anti-rheumatic drugs, screening for HBV is recommended before starting immunosuppressive or immunomodulatory therapy. The aim of this study was to select the best and simplest test for screening of HBV in rheumatic patients. This study was carried out in 102 patients with different rheumatic diseases. Screening to all patients for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies and human immune deficiency virus antibodies (HIV) was done. HBV core antibodies and real time PCR to detect HBV DNA were done. The mean age of the patients was 37.18 ± 12.37 years, 3.9% of them were males and 96.1% were females. HBsAg had 100% Sensitivity, 100% Specificity, 100% PPV, 100% NPV and 99.0% accuracy. While, anti-HBc had 100% Sensitivity, 78% Specificity, 8% PPV, 100% NPV and 78% accuracy in the screening of HBV. HBs Ag was found to be superior to antiHBc for screening for HBV infection in rheumatic patients.

Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers.

Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening. We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses. There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers. Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.

Evaluation of Hepatitis B Reactivation Among Patients with Chronic Myeloid Leukemia Treated with Tyrosine Kinase Inhibitors

The risk of HBVr in chronic myeloid leukemia (CML) has been reported in many studies but there are no clear guidelines or recommendation regarding screening and monitoring of HBV in CML patients receiving tyrosine kinase inhibitors (TKIs). This review addresses the following questions regarding screening, monitoring, prophylaxis and treatment of HBVr in CML patients receiving TKIs: Who should be screened before starting TKIs?Which type of screening test should be used?Should HBV DNA be used to screen or monitor the patients before starting TKI?What is the best timeline to monitor HBV reactivation? METHODS: Studies from the year 2000 to date were searched on PubMed and Google Scholar, which investigated the possibility of HBV reactivation on patients with CML treated with TKIs. 11 studies were selected and reviewed. All patients are above 18 years old, diagnosed with CML on TKI treatment, were included in this review. Patients with any hepatitis serology marker at baseline (upon diagnosis of CML) were also included. Patients with active hepatitis B infection before the start of TKIs were excluded from the review. RESULTS: We identified 25 reported cases of hepatitis B reactivation after TKI treatment. 22/25 had HBsAg positive at baseline (before starting TKI) and 1/25 had HBsAg negative at baseline. The remaining 2/25 had reactivation with no clear baseline test results. These results are illustrated in Table 1. DISCUSSION: HBVr is defined by changes in (ALT) levels, HBV serological markers, or HBV DNA. Thus, HBVr is considered when: A 2- to 3-fold increase of ALT above baseline or the upper limit of normal.A reverse hepatitis B surface antigen (HBsAg) seroconversion or detection of HBV DNA in the blood in the absence of HBsAg.A newly detected HBV DNA or a ≥10-fold (1log10) rise in HBV DNA level.The risk of HBVr in patients receiving tumor necrosis factors (TNF), moderate-to-high dose steroids for 4 weeks, and TKIs was reported to be moderate (1-10%), and recommended for HBV prophylaxis as well. However, the strength of such recommendation is weak. It is advisable to screen all patients who are planned for TKI treatment. Suitable screening tests include HBV DNA, HBsAg, and ALT. It is important to identify patients with previous HBV infection, as evidenced by hepatitis B serological markers, i.e. positive hepatitis B core antibody (anti-HBc), with negative HBsAg, with or without detectable hepatitis B surface antibody (HBsAb). Nevertheless, running all tests may not be feasible due to costs and availability of testing equipment. Therefore, if unavailable, testing patients using only ALT and HBsAg, or even ALT alone would suffice, as the detection of HBVr can be deduced from ALT/HBsAg levels alone. For HBsAg positive patients, prophylaxis against Hepatitis B reactivation should be started as HBVr may happen any time after commencement of TKIs. There is no clear answer in the literature as to which antiviral should be used. However, entecavir was most commonly used in the studies (other antivirals used include tenofovir and lamivudine). The duration of prophylaxis was also not mentioned in the literature. CONCLUSION: As the definition of hepatitis B reactivation includes a rise of ALT (2- to 3-fold), HBV DNA (newly detected to 10-fold increase) and seroconversion in HBsAg negative patients, all patients with CML should have baseline values of ALT, hepatitis B serology as well as HBV DNA before starting TKI treatment and should be followed up with repeat values of these 3 parameters. However, due to the cost and limited availabilities of these tests, we suggest following up at least ALT levels (preferably with HBsAg levels) before and after treatment with TKIs. In patients with risk of HBVr (i.e. positive HBsAg on screening, as well as those with resolved HBV infection), prophylaxis is important. Based on currently available evidence, we recommend HBV prophylaxis for patients with positive HBsAg receiving TKIs to be given from the start of TKI treatment, and continued for at least 1 year after the commencement of TKIs, if feasible. In the event that this is not affordable, it is advisable to monitor markers of reactivation, as mentioned above (i.e. ALT, HBsAg, HBV DNA, whichever is available). For those with resolved HBV infection (i.e. positive anti-HBc and negative HBsAg), we recommend monitoring for signs of HBVr during the treatment duration. Table 1 Disclosures No relevant conflicts of interest to declare.

COVID-19 and hepatitis B infection.

The 2019 coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a major burden worldwide, resulting in serious public health challenges. HBV infection is another widely spread virus that chronically affects about 257 million people. The management of patients with HBV infection has gained attention in the context of the COVID-19 pandemic. Patients with COVID-19 have varying levels of liver involvements, resulting from direct viral effects on the liver as well as hepatotoxic drugs. This was demonstrated by elevated levels of liver enzymes, particularly evident in those patients with severe SARS-CoV-2 infection. However, scarce information is available on the management of COVID-19 patients having an underlying chronic liver disease, including HBV infection. Studies have shown reactivation of HBV infection following treatment with tocilizumab and corticosteroids, emphasizing the need for caution when using these agents to treat COVID-19 patients with HBV infection. HBV screening and prophylaxis should be considered in patients with elevated transaminase levels and also in high prevalence populations. In patients with advanced liver disease, attention must be given to minimize the risk of liver decompensation. Nevertheless, further investigation is needed to enable an evidence-based approach for the care of these patients.

A new strategy for screening infectious diseases amongst migrants: the STRADA study

Abstract Background In France, the prevalence of HIV, HBV and HCV is high amongst migrants and widespread testing is recommended. All legal migrants in France undergo a mandatory medical check-up at the immigration center (OFII). This check-up is an opportunity to offer rapid HIV and hepatitis testing. A screening questionnaire for risk factors (TROD screen) has been developed and could help target the screening offer. The objective of the STRADA study is to evaluate the efficacy of a screening strategy for infectious diseases (Tuberculosis, HIV, HBV and HCV) based on risk-factor questionnaires amongst migrants during the medical check-up. Methods STRADA is a prospective, multicenter, observational study with two parts: tuberculosis screening (evaluation of a screening questionnaire) and HIV, HBV and HCV screening. For that part we have created a risk-based questionnaire for those three infections. In the first phase of the study, all migrants eligible are offered a screening, the TROD screen questionnaire. In the second phase, the screening offered on the basis of country of origin will be compared to the screening offered on the basis of the risk factor questionnaire. Finally, a cost-effectiveness study will be performed. During the informed consent process, participants are informed that the study is voluntary and independent from the residence permit. Preliminary results A risk-based questionnaire has been created and translated in 10 languages. The screening has been implemented in 20 immigration centers in France. In April 2019, 35,000 participants have answered the TB screen and 8,250 have been screened for at least one of the three virus. Discussion This study will determine the acceptability, performance, utility, costs and impact of a targeted optimized screening strategy for migrants in France. The presence of infectious diseases amongst migrants is a major public health issue. STRADA is an innovative initiative that has the potential to improve screening.

Integrating HBV, HCV and HIV screening in tuberculosis entry screening for migrants in the Netherlands

Abstract We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV) screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCVpositive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37-8.29) and 0.99% (2/203; 95% CI: 0.27-3.52), respectively, all infections were newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07-2.18), 1.17% (3/256; 95% CI: 0.40-3.39) and 0.39% (1/256; 95% CI: 0.07-2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12-26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00-0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis screening. Prescreening selection of migrants based on risk factors merits further exploration.