title: Screening for tuberculosis and hepatitis B prior to the initiation of anti-tumor necrosis therapy.
abstract: BACKGROUND
  Since the introduction of infliximab, anti-tumor necrosis factor alpha (anti-TNF-α) agents have been used with increasing frequency for the treatment of inflammatory bowel disease (IBD). Reactivation of latent Mycobacterium tuberculosis (TB) soon became recognized as a complication of therapy. More recently, reactivation of hepatitis B while on anti-TNF therapy has been documented. The aim of this study was to assess the adherence to screening for latent TB and hepatitis B by gastroenterologists prior to initiation of an anti-TNF.
  
  
  METHODS
  This is a retrospective analysis of all patients with IBD treated with an anti-TNF at a large urban academic hospital. In our population, 65% of patients were screened for latent TB prior to the initiation of anti-TNF therapy, while 25% of patients were screened for hepatitis B.
  
  
  RESULTS
  Failure to screen for latent TB was strongly correlated with prior exposure to an anti-TNF (odds ratio [OR]: 5.3; P < 0.0001) and initiation of treatment prior to 2006 (OR: 5.8; P < 0.0001). Failure to screen for hepatitis B was associated with lack of an abnormal alanine aminotransferase (OR: 2.6; P = 0.005) and treatment prior to 2010 (OR: 3.3; P = 0.02). Providers who had been in practice longer were less likely screen for TB or hepatitis B.
  
  
  CONCLUSIONS
  The rate of screening for both latent TB and hepatitis B in this study was inadequate. While the rate of screening is increasing, further systems improvements and physician education is needed.
authors.affiliation: Division of General Medicine and Primary Care, St. Vincent's University Hospital/University College Dublin, Ireland. bvaughn@bidmc.harvard.edu
authors.forename: Byron P
authors.initials: BP
authors.lastname: Vaughn
authors.forename: Glen A
authors.initials: GA
authors.lastname: Doherty
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Alan C
authors.initials: AC
authors.lastname: Moss
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000209:etiology*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000472:pathogenicity; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab