P141 Evaluation of a specialist multi-disciplinary team in the management of patients at risk of hepatitis B virus reactivation

<h3></h3> Hepatitis B (HBV) is a viral infection, which 1 in 3 of the world’s population are believed to have been infected with.¹ Of those, more than 95% will spontaneously clear the virus, developing protective immunity.² However, despite hepatitis B surface antigen (HBsAg) clearance, covalently closed circular DNA (cccDNA), the transcriptional template for HBV, remains within hepatocytes. cccDNA continues to be fully replication competent.³ This is not targeted by current HBV antiviral therapies. In the presence of immune suppression, it may lead to HBV reactivation (HBV-r).⁴ Immunosuppressants and immunomodulators are increasingly prescribed for a range of medical conditions. HBV-r is linked to an increase in morbidity and can be fatal.⁵ The risk of HBV-r considers host factors, such as age and gender, viral factors, and type of immunosuppression. Risk is then categorised as high (&gt;10%), moderate (1–10%) and low (&lt;1%).⁶ However, this is largely preventable if screening prior to commencing immunosuppressive treatment takes place.⁶ The Hepatology unit at University Hospitals Birmingham developed and piloted an HBV-r management pathway. Individuals with hepatitis B surface antigen and/or hepatitis B core antibody positivity prior to immunosuppression were directly referred into a specialist multi-disciplinary team (MDT) for risk assessment of HBV-r. HBV management plans were then provided to the referring clinicians. Here we present data for the first 100 patients referred to the MDT. 84 patients with positive HBcAb and negative HBsAg were referred to the MDT between November 2021 and September 2023. In addition, 11 with chronic HBV, both already known and newly diagnosed were referred. 3 further patients were thought to have a false positive HBcAb related to recent intravenous immunoglobulin infusion and 2 had negative HBcAb and HBsAg. 8 sadly, had died from their primary condition at time of data collection. Management of the 95 patients with current or past HBV is summarised in table 1. Recommended management options include antiviral prophylaxis (moderate-high risk) or monitoring of HBsAg (low-moderate risk) with pre-emptive treatment if HBsAg becomes positive.⁷ In conclusion, HBV-r is an ongoing risk for those with current or past HBV undergoing immunosuppressive treatment. As the use of immunosuppressant therapies becomes more widespread, it is important a robust pathway for HBV screening and HBV-r assessment is implemented to prevent potentially fatal consequences. <h3>References</h3> Hepatitis B Foundation. www.hepb.org/what-is-hepatitis-b/what-is-hepb/facts-and-figures/#:~:text=Two%20billion%20people%20have%20been,of%20infected%20individuals%20are%20diagnosed (Accessed 04/06/2024) Tripathi N, Mousa OY. Hepatitis B. [Updated 2023 Jul 9]. In: StatPearls [Internet]. Treasure Island (FL): <i>StatPearls Publishing</i>; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555945/ (Accessed 04/06/2024) Perrillo R. Overview of Hepatitis B Virus Reactivation. <i>Gastroenterology &amp; Hepatology.</i> July 2021;<b>17</b>(7):336–339. Smalles D, Kiger R, Norris L,<i> et al</i>. Hepatitis B virus reactivation: Risk factors and current management strategies. <i>Pharmacotherapy.</i> December 2019;<b>39</b>(12):1190–1203. Myint A, Tong MJ. Beaven SW. Reactivation of hepatitis B Virus: A review of clinicals guidelines. <i>Clinical Liver Disease.</i> April 2020;<b>15</b>(4):162–167. Su J, Kim JK. Hepatitis B virus reactivation in the setting of immunosuppressive drug therapy. <i>Gastroenterology &amp; Hepatology.</i> November 2019;<b>15</b>(11):585–592. Etienne S, Vosbeck J, Bernsmeier C,<i> et al</i>. Prevention of hepatitis B reactivation in patients receiving immunosuppressive therapy: a case series and appraisal of society guidelines. <i>Journal of General Internal Medicine.</i> September 2022:490–501.