Low awareness of and adherence to preventive guidelines for hepatitis B reactivation among Belgian specialist physicians: the CHOICe study

Despite preventive screening guidelines and antiviral prophylaxis, hepatitis B virus (HBV) reactivation continues to be a problem in clinical practice, resulting in patient mortality. The CHOICe study has two main research objectives: firstly, to identify knowledge gaps relating to hepatitis B and C virus (HCV) reactivation among Belgian specialist physicians; and secondly, to assess Belgian physicians’ adherence to HBV screening guidelines when prescribing chemotherapy and immunosuppressive therapy. The CHOICe study comprises two distinct parts: a questionnaire and a retrospective review of medical charts. First, a discipline-specific questionnaire (oncological [Q1] and non-oncological setting [Q2]) was disseminated in the hematology (H), oncology (O), inflammatory bowel disease (IBD), rheumatology (R), and dermatology (D) departments of 11 Belgian hospitals in Spring 2022. Second, a retrospective medical chart review was conducted in these departments in two academic and two general hospitals in Belgium between 2023 and 2024. During the retrospective study part, pretherapeutic HBV screening was evaluated according to EASL guidelines and patients with positive HBV serology were evaluated retrospectively for timely prophylaxis initiation. Low questionnaire scores show a general lack of awareness concerning HBV and HCV reactivation across all specialties ( n = 116, mean overall scores: total 36.2%, Q1 33.7%, Q2 40.2%). Pretherapeutic HBV screening rates were low in all specialties ( n = 2225, H – 72.0%; O – 21.5%; IBD – 61.2%; R – 29.7%; D – 34.0%). Few hematological and oncological patients were properly screened for HBV prior to administration of B-cell-depleting agents (56.5%) and anthracyclines (30.6%). Antiviral prophylaxis was initiated in only 4 out of 16 HBsAg + or HBsAg-/HBcAb+ patients at moderate to high risk of HBV reactivation. Three missed cases of HBV reactivation were documented. HBV reactivation is poorly known and poorly managed by Belgian specialist physicians prescribing chemotherapy and immunosuppression. Pretherapeutic HBV screening rates were suboptimal in both general and academic hospital settings. There is an urgent need for a national HBV and HCV screening protocol for patients initiating chemotherapy and immunosuppression, in order to prevent patient morbidity and mortality due to HBV reactivation.