Lack of Awareness in the Detection of Hepatitis B Virus Presence in Patients to Receive Immunosuppressive Therapy: An Experience from a Tertiary Care Hospital

Introduction: Hepatitis B virus (HBV) reactivation in patients undergoing immunosuppressive therapy can be prevented with antiviral prophylaxis.It is recommended that all patients scheduled to receive immunosuppressive treatment be screened for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBcIgG), antibody against hepatitis B surface antigen (anti-HBs), hepatitis C virus antibody (anti-HCV), and human immunodeficiency virus antibody (anti-HIV) before the initiation of therapy.In this study, we aimed to evaluate the screening rates for HBV and the rates of appropriate preemptive treatment and prophylaxis among patients receiving immunosuppressive therapy. Materials and Methods:This study included patients over the age of 18 who received immunosuppressive treatment for various reasons between January 1, 2017, and December 31, 2024, and whose data were fully accessible.Prior to the initiation of immunosuppressive therapy, patients were retrospectively evaluated for HBsAg, anti-HBs, and anti-HBc IgG screening, and whether they were appropriately referred for prophylactic or preemptive treatment based on the results.Results: Data from 81 patients were fully accessible.It was determined that 48 patients were screened for all three HBV markers (HBsAg, anti-HBs, and anti-HBcIgG) before immunosuppressive therapy, while 18 patients had not undergone any HBV serological testing.In 15 patients, only HBsAg and anti-HBs were tested.All patients who were either not screened or partially screened were those receiving cytotoxic chemotherapy for solid organ malignancies.In contrast, patients receiving immunosuppressive or cytotoxic chemotherapy due to hematological malignancies, rheumatological diseases, or vasculitis had all undergone complete HBV serological testing prior to treatment.All of these patients received appropriate prophylactic treatment for HBV.Among the 18 patients with solid organ malignancies who were not screened before chemotherapy, two developed acute HBV reactivation.Entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide were used for prophylactic treatment.None of the patients who received prophylaxis experienced HBV reactivation. Conclusion:While rheumatologists and hematologists demonstrated high awareness of the risk of hepatitis B reactivation, there remains a need to enhance interdisciplinary educational efforts to improve awareness among oncologists on this issue.