If the hepatitis B virus remains for more than 6 months in the blood it is likely to develop into chronic hepatitis B. Controlled vocabulary supplemented with key words was used to search Ovid Medline, Ovid Embase, and PubMed from January 2009 through January 2020 (Data Supplement). However, recent data have called into question the utility of risk-adaptive models for HBV screening. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Patients with MCC are a complex and heterogeneous population, making it difficult to account for all of the possible permutations to develop specific recommendations for care. Among patients with past HBV, if the anti-HBs is positive, then this is considered resolved HBV infection; if the anti-HBs is negative, then this is considered isolated anti-HBc–positive. Patient information is available at www.cancer.net. Even if HBV treatment is not indicated during their cancer treatment, it is important for them to receive ongoing care for their HBV, including assessment for long-term antiviral therapy based on standard HBV guidelines and evaluation for HCC screening. Vaccination can be recommended, taking into consideration a patient’s clinical situation and timing. Articles were excluded from the review if they were (1) meeting abstracts not subsequently published in peer-reviewed journals; (2) editorials, commentaries, news articles, case reports, narrative reviews, or studies of children; and (3) published in a non-English language. Zhang X, Wang D, Chen Z, Guo N, Wang W, Xiong C, Liu J, Yue Y, Sun M. Medicine (Baltimore). 2020 Jun 5;99(23):e20638. Awareness of these disparities in access to care should be considered in the context of this clinical practice guideline, and health care providers should strive to deliver the highest level of cancer care to these vulnerable populations. Follow-up testing after the cessation of anticancer therapy is likely not necessary (Type of recommendation: informal consensus, benefits outweigh harms; Strength of recommendation: strong). Hepatitis B virus (HBV) infection is a major public health burden in France and worldwide. [Improvement of vaccination activities in urology]. As such, anti-HBc testing after IVIG should be interpreted with caution. Patients with a detectable anti-HBs but who are negative for HBsAg and anti-HBc can be counseled that they have protective levels of antibody from previous vaccination. DOI: 10.1200/JCO.20.01757 Journal of Clinical Oncology - J.P.H. Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance Norah A. Terrault,1 Anna S.F. However, the following large, prospective cohort studies3,8,18 provide strong, albeit indirect, evidence that supports universal HBV screening in patients with cancer. While prospective studies are needed, they would likely be impractical; thus, large, multicenter retrospective studies with long-term follow-up may be a preferred option. Hepatitis flares, presenting as elevated ALT levels, can occur after the discontinuation of antiviral therapy. Testing for HBsAg now is recommended for: persons born in geographic regions with HBsAg prevalence of ≥ 2% US born persons not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of ≥8% 2014;161(1):58-66. Some people with hepatitis B are sick for only a few weeks (known as “acute” infection), but for others, the disease progresses to … In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. DOI: 10.1200/JCO.20.01757 Journal of Clinical Oncology The information is not continually updated and may not reflect the most recent evidence. Randomized clinical trials of universal HBV screening compared with HBV risk-based or no HBV screening are considered unethical to conduct, as patients with known HBV risk factors might be not tested. The involvement of general practitioners in the early detection of viral hepatitis B and C must be paramount. In addition, patients with past HBV, especially those who are not receiving anti-CD20 therapy or stem-cell transplantation, have a lower risk of HBV reactivation than those with chronic HBV; studies should be conducted to elucidate optimal clinical care paths for these patients. Permissions, Authors Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update (http://ascopubs.org/doi/10.1200/JCO.2016.70.1474), Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline (http://ascopubs.org/doi/10.1200/JCO.2017.75.2311), Clinical Practice Guidelines Committee approval: June 2, 2020. We also thank Laurissa Gann, MSLS, AHIP, Manager, Education & Access Services, at MD Anderson Cancer Center for her assistance with the review of the literature; and Leticia Nogueira, PhD, MPH, Senior Principal Scientist, Health Services Research at the American Cancer Society, for conducting analyses to inform this PCO. bei besonders schwerem Verlauf einer Hepatitis B, können Anti-HDV und HDV-RNA untersucht werden. Response categories of “Agree as written,” “Agree with suggested modifications,” and “Disagree. Download Hepatitis B antenatal screening and newborn immunisation programme - Best practice guidance (updated June 2011) PDF , 450KB , 57 pages This file … Newer anti-HBV antiviral therapies are in development that may allow a functional cure or sustained HBsAg clearance and undetectable viral levels.34. Most of these patients have received highly immunosuppressive lymphodepleting regimens and prior anti-CD20 exposure. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. More information, including a supplement with additional evidence tables, slide sets, and clinical tools and resources, is available at www.asco.org/supportive-care-guidelines. Patients who have isolated anti-HBc may need further work-up because the HBV management for these patients depends on the type of anticancer therapy administered. Among patients who have isolated anti-HBc–positive with negative HBsAg and anti-HBs, studies have shown that protective levels of anti-HBs can decrease risk of HBV reactivation,19-21 Thus, future research should assess the efficacy of HBV vaccination to achieve protective anti-HBs levels,53 which could decrease risk of HBV reactivation.19-21. Systems-based approaches have been used to address barriers to the implementation of universal HBV screening in primary care populations. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. A substantial proportion of the Singapore population falls within the lower socioeconomic strata given that the median monthly household income in 2012 was USD$5200 [19] . Most published efforts use electronic health records (EHR). More information, including a supplement with additional evidence tables, slide sets, and clinical tools and resources, is available at www.asco.org/supportive-care-guidelines. These persons include those … This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. Wilt TJ, Shamliyan T, Shaukat A, Taylor BC, MacDonald R, Yuan JM, Johnson JR, Tacklind J, Rutks I, Kane RL. 2019 Nov;58(11):1353-1360. doi: 10.1007/s00120-019-01055-1. As such, ALT levels should be monitored frequently, at least monthly for the first 3 months after the cessation of antiviral therapy and every 3 months thereafter. To understand the tests described below, it might help to know two medical terms: antigen and antibody. Epub 2017 Apr 18. In our PCO (Fig 1), we use a simplified cut-off threshold of HBV DNA > 1,000 IU/mL to assist and guide oncology providers with respect to the threshold above which further management is warranted in patients with past HBV infection. JCO Oncology Practice TABLE 3. All patients with cancer anticipating systemic anticancer therapy should be tested for hepatitis B virus (HBV) by 3 tests—hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen (anti-HBs)—prior to, or at the beginning of, systemic anticancer therapy. However, hormonal therapy with steroids such as used with abiraterone plus low-dose prednisone31 could confer a higher risk of HBV reactivation than hormonal therapy alone, and these patients may need a personalized management plan including antiviral prophylaxis or close monitoring. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents, hence, laboratory confirmation of the diagnosis is essential. Participants completed a survey about viral risk factors drawn from the National Health Interview Survey and the Centers for Disease Control and Prevention (CDC) and had serologic testing for HBV, HCV, and HIV. Chronic HBV infection, as part of its natural course, may lead to cirrhosis, liver failure, and/or hepatocellular carcinoma (HCC). Use of the information is voluntary. Our Panel specifically identified a research gap of HBV reactivation risks for the growing list of agents that deplete or modulate B cells. The risk of HBV reactivation among patients with solid tumors—who make up the majority of patients with cancer—is very likely lower than for patients with hematologic malignancies. (§) An alternative pathway is careful monitoring with HBsAg and HBV DNA every 3 months with immediate antiviral therapy at the earliest sign of HBV reactivation so long as patients and providers are able to adhere to frequent and consistent follow-up during and for up to 12 months after last anticancer therapy (see text for details). 31 Notably, 2 panel members in 2015 offered a minority viewpoint, namely, a strategy of universal HBsAg and selective anti-HBc testing. Get the latest research from NIH: https://www.nih.gov/coronavirus. If evidence of HBV infection, do not delay anticancer therapy while obtaining further testing or referrals. The following summarizes the interpretation of test results with these three serologic tests (). However, the specificities of the brief tools were low (< 15%), likely due to the high prevalence of having at least one of the significant risk variables in the models—for instance, 76% of the participants were > 50 years of age. ASCO Daily News  |  The following represents disclosure information provided by authors of this manuscript. It is clear that for anti-HBc–positive patients receiving high-risk anticancer therapies like anti-CD20 monoclonal antibodies or stem-cell transplantation, the risk of reactivation is substantial and either close monitoring or preemptive antiviral therapy is recommended. and A.S.A. Patients with past HBV undergoing other systemic anticancer therapies not clearly associated with a high risk of HBV reactivation should be monitored with HBsAg and alanine aminotransferase during cancer treatment; antiviral therapy should commence if HBV reactivation occurs. This could be explored using geriatric assessments to improve patient-centered communication about cancer care and management of comorbid conditions, as well as aging concerns.48. In 2019, Ramsey et al8 published a study of HBV, hepatitis C virus (HCV), and HIV screening among 3,051 patients with a hematologic malignancy or a solid tumor awaiting any anticancer therapy over a nearly 42-month period of time during 2013-2017 among 18 institutions within the SWOG Cancer Research Network, a member of the National Clinical Trials Network. NYU Langone doctors provide screening for hepatitis B and hepatitis C, two forms of hepatitis that can become chronic and lead to serious liver damage without treatment. All patients anticipating systemic anticancer therapy should be tested for HBV by 3 tests—hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen—but anticancer therapy should not be delayed. July 27, 2020. These patients are not at risk for transmission through sexual or close personal contact.17. 3.5 Hepatitis E Anti-HEV IgM: Screening auf akute Hepatitis E Liver ultrasound. Universal HBV screening before the start of anticancer therapy for patients with solid tumors was found to be cost effective in analyses conducted by Konijeti et al65 and by Wong et al67 but not cost effective in analyses conducted by Hwang et al63 and Tan et al.66 Additional research is needed on HBV screening to address cost effectiveness more definitively, particularly in patients with solid tumors for whom adequate data on the reactivation risk of commonly used anticancer treatments are lacking. As such, ALT levels should be monitored frequently, at least monthly for the first 3 months after the cessation of antiviral therapy and every 3 months thereafter (Type of recommendation: informal consensus, benefits outweigh harms; Strength of recommendation: strong). 1 PCOs are based on a rigorous, evidence-based approach and are designed to offer timely clinical direction to ASCO membership following publication or presentation of potentially practice-changing … Asymptomatic rises in HBV DNA are very different from clinical hepatitis flares and thus should be interpreted with caution depending on the definitions used. [8,15,16] The anti-HBc test may consist of a The pattern of test results can identify a person who has a current active infection, was exposed to HBV in the past, or has immunity as a result of vaccination. The members of the Expert Panel are listed in Appendix Table A1 (online only). Hepatitis B blood tests detect viral proteins (antigens), the antibodies that are produced in response to an infection, or detect or evaluate the genetic material (DNA) of the virus. You will usually be offered the blood test at your booking appointment with a midwife. Das hat der Gemeinsame Bundesausschuss (GBA) auf … Should their anticancer treatment regimen change beyond hormonal therapy alone, the risk of HBV reactivation based on their new anticancer therapy should be reassessed (Type: informal consensus, benefits outweigh harms; Strength of recommendation: moderate). Identifying the mechanism and risks of reactivation due to specific types of anticancer drugs has been problematic. In this study, 83 HBsAg-negative and anti-HBc–positive patients with a hematologic malignancy receiving anti-CD20 therapy were followed with frequent laboratories every 4 weeks without antiviral therapy. Interpretation of HBV Test Results. Routine screening for hepatitis B is not currently recommended in France. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation, such as anti-CD20 monoclonal antibodies or stem-cell transplantation, should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after the cessation of anticancer therapy. One exception may be the HBsAg-positive patient receiving hormonal therapy alone. Many other patients lack access to care because of their geographic location and distance from appropriate treatment facilities. Pegylated interferon alfa-2a, entecavir, and tenofovir are recommended as first-line treatment options for chronic hepatitis B. NLM JAMA Oncol [epub ahead of print on November 7, 2019], Seto WK, Wong DK, Chan TS, et al: Association of hepatitis B core-related antigen with hepatitis B virus reactivation in occult viral carriers undergoing high-risk immunosuppressive therapy. J Hepatol. Regardless of whether patients with past HBV infection have resolved HBV infection or isolated anti-HBc positivity (Table 3), it is important to note that covalently closed circular DNA remains and is capable of replicating in the liver of individuals with this serologic profile. The Clinical Practice Guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (ASCO) to assist providers in clinical decision making. (|) Hepatitis flare: alanine aminotransferase (ALT) > 100 U/mL and 3 times baseline.17 (¶) Long-term antiviral therapy management for patients with cancer after the cessation of anticancer therapy should follow national hepatology recommendations for all patients with chronic HBV.11,17 An HBV specialist is a clinician experienced in HBV management. Patients with past HBV infection undergoing anticancer therapies associated with a high risk of HBV reactivation, such as anti-CD20 monoclonal antibodies or stem-cell transplantation, should receive antiviral prophylaxis during and for minimum 12 months after anticancer therapy completion, with individualized management thereafter. Table 1 offers a summary of contemporary HBV screening guidelines. (‡) All other systemic anticancer therapy besides anti-CD20 therapy or stem-cell transplantation. Institutions Largely due to limited data, there has been an historical lack of agreement regarding the preferred approach to HBV serologic testing in individuals with cancer, and, as a result, HBV testing has been suboptimal.3-5 A range of strategies has been previously recommended.2,6,7 These include a universal screening approach in which all patients with cancer are tested, or a risk-adaptive approach that tests only those patients with cancer with risk factors for HBV infection or who would be treated with anticancer therapies associated with a high risk of HBV reactivation. The draft statements were released to the public for open comment from February 10, 2020, through February 24, 2020. Although ASCO clinical practice guidelines represent expert recommendations on the best practices in disease management to provide the highest level of cancer care, it is important to note that many patients have limited access to medical care. 2. The search, in combination with articles identified by individual Panel members, identified several practice guidelines that had been published since the 2015 PCO.6,11-16 The recommendations for HBV screening, use of serological tests, and antiviral prophylaxis from selected national and international guidelines are summarized in Table 1. This site needs JavaScript to work properly. Categories for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker's bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships.  |  Further, the information is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. TAPUR Study, Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update, Implementation of Universal HBV Screening. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Brief risk tools of 5-7 items were developed, which yielded high sensitivities of 99%-100%. The investigators found that the sensitivity and specificity of the HBV risk factor questions were 46% and 56%, respectively. The reactivation risk identified from rituximab has been extended to other anti-CD20 therapies, including obinutuzumab and ofatumumab. 2008. This information does not mandate any particular course of medical care. Enter words / phrases / DOI / ISBN / authors / keywords / etc. Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus e-antigen. Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it's acute or chronic. HBV DNA should be obtained at baseline and followed every 6 months during antiviral therapy. Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). HBV DNA should be obtained at baseline and followed every 6 months during antiviral therapy. Future studies will be needed to make universal HBV screening and linkage to care efficient and systematic, likely based in EHR systems. I = Immediate Family Member, Inst = My Institution. Anticancer therapy should not be delayed for the results of these screening tests. Safety and efficacy of REP 2139 and pegylated interferon alfa-2a for treatment-naive patients with chronic hepatitis B virus and hepatitis D virus co-infection (REP 301 and REP 301-LTF): a non-randomised, open-label, phase 2 trial. Patients who are negative for all HBV screening tests (negative HBsAg, anti-HBc, and anti-HBs) are considered not to be immune to HBV, have never been exposed to HBV, and may benefit from HBV vaccination,14 taking into consideration a patient’s clinical situation and timing of anticancer therapy. This group included about 43% of patients diagnosed with breast cancer and 23% of patients diagnosed with prostate cancer. were Expert Panel co-chairs. Findings of chronic HBV (HBsAg-positive) or past HBV (HBsAg-negative and anti-HBc–positive) infection require HBV reactivation risk assessment. Hepatitis B is a liver infection caused by the hepatitis B virus. Research Funding: Gilead Sciences (Inst), Merck Sharp & Dohme (Inst), Other Relationship: Asian Health Foundation, Consulting or Advisory Role: Abbott Laboratories, Roche, Enanta Pharmaceuticals, GlaxoSmithKline UK, Arbutus Biopharma, Research Funding: Gilead Sciences (Inst), Janssen (Inst), AbbVie (Inst), Wako Diagnostics (Inst), Stock and Other Ownership Interests: Radial Analytics (I), Research Funding: Merck (Inst), AiCuris (Inst), Consulting or Advisory Role: Gilead Sciences, Janssen Medical Affairs, Consulting or Advisory Role: Tivity Health, Travel, Accommodations, Expenses: Tivity Health, Other Relationship: Global Liver Institute, Consulting or Advisory Role: AIM Specialty Health, Consulting or Advisory Role: Dova Pharmaceuticals, Research Funding: Gilead Sciences (Inst), AbbVie (Inst), Roche/Genentech (Inst), Travel, Accommodations, Expenses: Dova Pharmaceuticals, Uncompensated Relationships: Gilead Sciences, Stock and Other Ownership Interests: Roche/Genentech (I), Open Payments Link: https://openpaymentsdata.cms.gov/physician/331072. It often does not cause any obvious symptoms in adults, and typically passes in a few months without treatment. The Methodology Manual (available at www.asco.org/guideline-methodology) provides additional information about the methods used to develop this guideline. Urologe A. Hepatitis B surface antibody Marker of immunity a The presence of anti-HBs is generally interpreted as indicating recovery and immunity from HBV infection. Patients with a negative anti-HBs may be at higher risk of HBV reactivation than patients who have a positive anti-HBs. Hepatitis B vaccination is recommended for medically stable infants weighing 2,000 g or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of infection. Additional information is available at www.asco.org/supportive-care-guidelines. HBV screening and linkage to care using EHR in the cancer population. Hormonal therapy without systemic anticancer therapy is unlikely to increase the risk of HBV reactivation in patients with chronic or past HBV. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST. In one study, a multidisciplinary team of clinicians, pharmacists, and public health professionals prospectively studied HBV screening and antiviral use among patients in the Veterans Health Administration receiving anti-CD20 therapy.25 Using a comprehensive set of multimodal interventions, which included pharmacy staff checking for HBV screening and treatment prior to anti-CD20 therapy and an electronic medication order review to assess appropriate HBV testing and antiviral treatment before anti-CD20 therapy, investigators found that HBV screening prior to anti-CD20 therapy increased national rates of HBV testing to > 90% and antiviral prophylaxis to > 80%. Low level of hepatitis B virus screening among patients receiving chemotherapy, AASLD guidelines for treatment of chronic hepatitis B, Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement, Hepatitis B management during immunosuppression for haematological and solid organ malignancies: An Australian consensus statement, Hepatitis B Vaccination, screening, and linkage to care: Best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention, Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, INASL guidelines on management of hepatitis B virus infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids, Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance, Prevalence of hepatitis B and C and 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2020 hepatitis b screening