These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Overuse of prophylaxis in HBsAg and/or anti-HBc positive patients after increasing awareness to prevent reactivation in patients receiving immunosuppressive therapies: How rational are our prophylaxis decisions according to the literature?
    Author: Yenilmez E, Cetinkaya RA.
    Journal: Infez Med; 2019 Sep 01; 27(3):299-307. PubMed ID: 31545774.
    Abstract:
    Screening prior to initiation of immunosuppressive therapy, and decision making between the initiation of hepatitis B virus (HBV) prophylaxis and monitoring with the intent of on-demand anti-HBV therapy initiation are the key determinants to prevent reactivation of HBV. Patients over 18 years of age with HBsAg and/or anti-HBc positivity, who received HBV prophylaxis due to immunosuppressive treatments between 2013 and 2019, enrolled in this retrospective descriptive study. We tried to create awareness about the reactivation of hepatitis among clinicians in our hospital from the beginning of 2017, via warnings at the hospital data management system and via in-service training activities. Changes or differences between two-time period groups (first group between 2013 and 2016, the second between 2017 and 2018) and between four reactivation risk groups (low, moderate, high and very high) were analyzed. Of 125 patients who received immunosuppressive therapies and HBV prophylaxis, 52 (41.6%) were HBsAg positive while 73 (58.4%) were anti-HBc positive/HBsAg negative. Eighteen of the patients were in the 1st-period-years and 107 were in the second. The ratio of anti-HBc positive/HBsAg negative patients increased from 22.22% (n: 4) to 64.49% (n: 69) in the 2nd period (p: 0.001). In the 1st period, 16.67% of the patients had hepatitis B surface antibodies (anti-HBs), which increased to 46.73% during the 2nd period. The ratio of patients with HBV DNA positivity was found to be 55.56% in the first period and 33.87% in the second. Patients in the moderate (1-10%) and high (10-30%) reactivation risk groups were predominant, with rates of 38.89% and 33.33% of all the patients during the 1st period, respectively. However, the number of patients with a low reactivation risk increased 19-fold (from 2 to 38) and reached a proportion of 35.51% of all patients during the 2nd period. There was also a 6.33-fold increase (from 6 to 38) in the number of patients with high reactivation risk, reaching a rate of 35.51% during the 2nd period. None of the patients developed HBV reactivation when HBV prophylaxis was initiated before (n:11), concurrently (n:81) with or after (n:33) the immunosuppressive therapy. Awareness of HBV reactivation among clinicians has significantly increased in recent years mainly due to in-service training activities in our hospital. This rapid progress in awareness resulted in increased rates of screening for HBV and therefore increased the number of anti-HBc positive/HBsAg negative patients. However, it also led to the overuse of HBV prophylaxis even in low-risk patients.
    [Abstract] [Full Text] [Related] [New Search]