title: Dermatologists' awareness of and screening practices for hepatitis B virus infection before initiating tumor necrosis factor-α inhibitor therapy.
abstract: OBJECTIVE
  The aim of the study was to assess dermatologists' awareness of available guidelines and drug package insert information on the screening for and management of hepatitis B (HBV) infection in patients receiving tumor necrosis factor-α inhibitor (TNF-αI) drug therapies for dermatological disorders.
  
  
  METHODS
  An electronic descriptive cross-sectional questionnaire was administered to a random, nationwide sample of physician members of the American Academy of Dermatology. Each participating physician answered 8 questions regarding his or her awareness of the risk of HBV reactivation.
  
  
  RESULTS
  More than half of the dermatologists surveyed (52%) were aware of guidelines regarding TNF-αI use in dermatological disorders. Dermatologists who were aware of the guidelines performed universal screening 81% of the time versus 3% of those who were unaware. Approximately 30% of the dermatologists were aware of drug manufacturers' package insert warnings for risk of HBV reactivation with TNF-αIs. Screening in their high-risk patients was highly variable because >90% performed screening in patients with a history of hepatitis or with elevated liver-associated enzymes. Most (73%) screened appropriately with HB surface antigen. One case of HBV reactivation was observed with infliximab use for psoriasis treatment.
  
  
  CONCLUSIONS
  Based on this survey, improving education among dermatologists regarding the risks of HBV reactivation and its prevention for patients receiving TNF-αI seems warranted. More specific consensus guidelines are recommended to achieve universal screening as the standard of care in these patients.
authors.affiliation: Georgetown University Hospital, Washington, DC 20007, USA. jonathan.stine@gmail.com
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.forename: Michael
authors.initials: M
authors.lastname: Bass
authors.forename: Dalia
authors.initials: D
authors.lastname: Ibrahim
authors.forename: Omar S
authors.initials: OS
authors.lastname: Khokhar
authors.forename: James H
authors.initials: JH
authors.lastname: Lewis
mesh_terms: D001364:Awareness; D000075202:Contraindications; D003430:Cross-Sectional Studies; D003880:Dermatology / Q000706:statistics & numerical data*; D004348:Drug Labeling; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D055502:Secondary Prevention; D012871:Skin Diseases / Q000150:complications / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha