title: Hepatogastroenterologists' knowledge of inactive carriers and immunotolerant hepatitis B virus patients in France: results of a practice survey.
abstract: BACKGROUND
  Before the 2012 revision of the EASL guidelines for the management of hepatitis B virus infection, we conducted a survey to determine how French nonacademic hepatogastroenterologists defined inactive hepatitis B virus carriers and immunotolerant patients.
  
  
  METHODS
  We asked 680 hepatogastroenterologists to complete a simple survey consisting of 11 multiple-choice questions.
  
  
  RESULTS
  The participation rate was 32%. HBeAg positivity was not identified as a key criterion for the diagnosis of immunotolerance by 61.9% of the respondents. A total of 82.5 and 75.9% of the respondents identified repeatedly normal alanine transaminase levels and repeatedly low viremia (<2000 IU/ml), respectively, as relevant criteria for the HBsAg inactive carrier state. The question on the biological monitoring of inactive carriers and immunotolerant patients was answered by 78% of the respondents, 97% of whom considered determinations of α-fetoprotein concentration and viremia every 6 (n=58, 35%) or 12 months (n=105, 63%) to be useful. Overall, 19% of the respondents declared never having treated an immunotolerant patient; 81% reported that they had treated such patients under some circumstances: 73% before immunosuppression or chemotherapy, 54% treated pregnant women in their third trimester when viremia was greater than 7 log IU/ml, 49% treated health professionals to prevent contamination, and 31% before medically assisted procreation.
  
  
  CONCLUSIONS
  The definition of 'inactive carrier state' seems to have been well assimilated, but immunotolerance remains poorly understood. Biological monitoring was frequently carried out for inactive carriers and immunotolerant patients, but the diversity of the responses obtained highlights the lack of clear recommendations for the follow-up of these populations.
authors.affiliation: aDepartment of Hepatology, Gastroenterology and Digestive Oncology, Regional Hospital, Orléans bDepartment of Hepatology, Gastroenterology and Nutrition, Laennec Hospital, Creil cDepartment of Hepatogastroenterology, Millenium Clinic, Montpellier dDepartment of Hepatogastroenterology, South Paris Region Hospital, Evry eDepartment of Hepatogastroenterology, General Hospital, Hyères fDepartment of Hepatogastroenterology, Palace Clinic, Grasse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Causse
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Pascal
authors.initials: P
authors.lastname: Potier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Hanslik
authors.forename: Jacques
authors.initials: J
authors.lastname: Denis
authors.forename: Christophe
authors.initials: C
authors.lastname: Renou
authors.forename: Patrick
authors.initials: P
authors.lastname: Delasalle
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D002353:Carrier State / Q000097:blood* / Q000276:immunology; D005260:Female; D005602:France; D005762:Gastroenterology; D007722:Health Knowledge, Attitudes, Practice; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy*; D027724:Reproductive Techniques, Assisted; D011795:Surveys and Questionnaires; D019562:Viral Load; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase