title: Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy.
abstract: Hepatitis B reactivation in patients undergoing immunosuppressive therapy can lead to liver failure and death. Prior studies have shown suboptimal hepatitis B screening rates, but few have compared screening rates across specialties or factors associated with screening.
  
  
  
  A retrospective study was performed using a hospital-based chemotherapy database and outpatient pharmacy records from January 1999 to December 2013. HBV screening rates prior to initiation of immunosuppression were determined. Multivariate analysis was used to determine predictors of HBV screening.
  
  
  
  Of the 4008 study patients, 47 % were screened prior to receiving immunosuppressive therapy; only 48 % on rituximab and 45 % of those on anti-TNF therapy were screened. Transplant specialists screened most frequently (85 %) while gastroenterologists screened the least (34 %). Factors significantly associated with HBV screening were younger age, Asian race, use of anti-rejection therapy, and treatment by a transplant specialist (p < 0.001).
  
  
  
  HBV screening prior to immunosuppressive therapy is suboptimal, especially among gastroenterologists. Efforts to improve screening rates in at risk populations are needed.
authors.affiliation: Division of Gastroenterology and Hepatology, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA, 02114, USA. sonali.paul2@gmail.com.
authors.forename: Sonali
authors.identifier: http://orcid.org/0000-0002-7799-5902
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Gastroenterology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL, 23309, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Shuja
authors.affiliation: Department of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA, 02111, USA.
authors.forename: Idy
authors.initials: I
authors.lastname: Tam
authors.affiliation: Department of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA, 02111, USA.
authors.forename: Eun Min
authors.initials: EM
authors.lastname: Kim
authors.affiliation: Tufts University School of Medicine, 145 Harrison Street, Boston, MA, 02111, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kang
authors.affiliation: Tufts University School of Medicine, 145 Harrison Street, Boston, MA, 02111, USA.
authors.forename: Leonid
authors.initials: L
authors.lastname: Kapulsky
authors.affiliation: Department of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA, 02111, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Viveiros
authors.affiliation: Division of Gastroenterology and Hepatology, Virginia Commonwealth University Medical Center, 1101 East Marshall Street, Richmond, VA, 23298-0663, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Lee
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001213:Asian / Q000706:statistics & numerical data; D015331:Cohort Studies; D000072085:Dermatologists; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D000072102:Gastroenterologists; D006084:Graft Rejection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000175:diagnosis*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy; D000072103:Oncologists; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy; D000072140:Rheumatologists; D000069283:Rituximab / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014775:Virus Activation; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab
keywords: Gastroenterologist; Hepatitis B; Reactivation; Rituximab; Screening