aThe risk of HBVr is low in the context of intra-articular steroids or a course of oral steroids for 7 days. individuals with resolved HBV infection receiving chemotherapy for haematological malignancies without antiviral prophylaxis, are at a decreased risk of HBVr when they have positive anti-HBs.14 More recently, the virological marker Hepatitis B core-related antigen (HBcrAg) Nonivamide was reported to be associated with an increased risk of HBVr in HBsAg-negative and anti-HBc-positive subjects undergoing high-risk immunosuppressive regimens.15 This test remains a research tool and is not routinely used in clinical practice. Early screening for HBV markers enables timely initiation of antiviral prophylaxis or treatment where indicated and reduces the risk of liver failure and death secondary to HBV reactivation in individuals receiving chemotherapy.16 Similarly, it also prevents any delay in starting defense suppression while Nonivamide awaiting professional input and/or additional investigations. Individuals with positive serology, particularly those with isolated anti-HBc, can be offered repeat screening.12 Individuals with negative serological markers who are likely to need immune suppression should be immunised against HBV and it is noteworthy that effective immunisation is more challenging with this context. The first dose of anti-HBV vaccine should be given 1C2 weeks before the administration of treatment and higher doses may be required in individuals who are Nonivamide immunocompromised. A minimum of three doses of vaccine given at regular monthly intervals are required for effective immunisation in individuals who are immunocompetent. ECCO recommends monitoring maintenance of anti-HBs in individuals at risk every 1C2 years.17,18 False positive screening for HBsAg can occur for 1C2 weeks following administration of the vaccine, because the assay can also detect surface antigen (sAg) in the vaccine preparation. Table ?Table22 shows the guidance from international societies on testing for HBV before immune suppression. Table 2. Recommendations on screening for hepatitis B disease markers before immunosuppression or chemotherapy SocietyWho should be screened?Screening testsAGAPatients at moderate or high risk of HBVrHBsAg, anti-HBc + HBV DNA in case of positive resultsASCOGroups at heightened risk for chronic HBV infection or if highly immunosuppressive treatment is definitely plannedHBsAg+- anti-HBc in some populationsCDCAll persons receiving cytotoxic or immunosuppressive therapyHBsAg, anti-HBc, and anti-HBsDGHOGroups at heightened riskHBsAg, anti-HBc + HBV DNA in case of positive resultsECCOAll IBD individuals at diagnosisHBsAg, anti-HBc, and anti-HBs + HBV DNA in case of positive resultsEASLAll candidates for chemotherapy and immunosuppressionHBsAg, anti-HBc, and anti-HBs +HBV DNA in case Nonivamide of positive results Open in a separate window AGA = American Gastroenterological Association; anti-HBc = hepatitis B core antibody; anti-HBs = hepatitis B surface antibody; ASCO = American Society of Clinical Oncology; CDC = Centers for Disease Control and Prevention; DGHO = German Society for Haematology and Medical Oncology; EASL = Western Association for the Study of the Liver; ECCO = Western Crohns and?Colitis?Organisation; HBsAg Rabbit polyclonal to PHC2 = hepatitis B surface antigen; HBV = hepatitis B disease; HBV DNA = hepatitis B disease DNA; HBVr = hepatitis B reactivation; IBD = inflammatory bowel disease Blood products and intravenous immunoglobulin Transfusion of blood products or infusion of intravenous immunoglobulin (IVIG) can result in passive transmission of antibodies associated with HBV. This can lead to individuals becoming falsely educated that there is evidence of past HBV or, more importantly, becoming regarded as for antiviral prophylaxis in the context of immunosuppression. Baseline anti-HBc should be measured early during the course of disease to avoid this scenario and, if bad, subsequent positive serology can be disregarded in the absence of ongoing risk of acquisition of HBV. Should liver function checks become deranged during the course of immune suppression, HBsAg should be retested,.