title: [Management of the risk of hepatitis B virus reactivation in patients receiving immunosuppressive and immunomodulatory agents in internal medicine: data from the REACTI-B survey and proposal for a management algorithm].
abstract: OBJECTIVE
  [corrected] This study aimed to evaluate the screening practices and management of the risk of hepatitis B virus (HBV) reactivation in patients receiving immunosuppressive and immunomodulatory agents in internal medicine departments and to propose a diagnostic and therapeutic algorithm.
  
  
  METHODS
  Descriptive, cross-sectional survey of the 1350 members of the French Society of Internal Medicine, which took place in France in January 2011 using an electronic questionnaire. Experts in the field of HBV infection proposed a decisional algorithm.
  
  
  RESULTS
  The overall response rate was 21.5%. Screening of HBV infection was performed in 44%, 68% and 76% of patients receiving or prior to initiating corticosteroids, immunosuppressive and immunomodulatory agents, respectively. Among participants, 35% had been confronted with one or several cases of HBV reactivation, mainly in patients receiving corticosteroids (54%), cyclophosphamide (34%) or rituximab (33%). Chronic, inactive carriers of HBV were considered to be at risk of reactivation in 89% of cases, while 41% of anti-HBc positive patients were considered at risk. In at-risk patients initiating immunosuppressive and/or immunomodulatory agents, 43% of practitioners consider the use of pre-emptive therapy, whereas 33% treat in case of confirmed reactivation. Systematic HBV vaccination of seronegative patients is planned in less than 50% of cases. Finally, 89% of participants feel they are not sufficiently educated regarding the risks of HBV reactivation and its prevention.
  
  
  CONCLUSIONS
  This survey highlights the need to improve the education of physicians regarding the risks of HBV reactivation prior to initiating corticosteroids, immunosuppressive and immunomodulatory agents, and to provide more specific guidelines for patients managed in internal medicine departments.
authors: Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, Paris, France.
authors: B
authors: B
authors: Terrier
authors: S
authors: S
authors: Pol
authors: V
authors: V
authors: Thibault
authors: J-E
authors: JE
authors: Gottenberg
authors: P
authors: P
authors: Cacoub
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007388:Internal Medicine; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014775:Virus Activation
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide