Impact of universal hepatitis B virus (HBV) screening using chemotherapy orders on the HBV reactivation in cancer patients

Abstract

Introduction Hepatitis B virus (HBV) reactivation (HBVr) induced by chemotherapy in patients with resolved or chronic infection can lead to severe consequences. Despite recommendations, rates of HBV screening before chemotherapy are low due to poor recognition of risk factors by clinicians. The aim of the study is to assess whether routine HBV screening using universal HBV screening on chemotherapy orders (CO) could reduce HBVr incidence. Methods This is a one-year retrospective single-center observational study of patients who received intravenous chemotherapy post implementation of CO. We compared the incidence of HBVr in three groups of patients: those screened through CO (group 1), those screened by the medical team (group 2) and those not screened (group 3). Results On a total of 1374 patients, 179 of 206 patients were screened as requested on CO (group 1) and 421 by the medical team (group 2), whereas 747 patients were not screened (group 3). Only 1 HBVr occurred, and no difference was seen on the incidence of HBVr between group 1 and group 3 (0% vs 0.1%; p=1.00), probably because of a lack of follow‑up after chemotherapy. Follow‑up for HBVr was imperfect in group 1 and group 2 (16.7% vs 5.6%; p=0.32). Screening was done for 92% of patients on anti‑CD20 therapy. In group 3, 89 patients had ALT elevation during chemotherapy but only 17 (19%) were tested for HBVr. Conclusion Universal HBV screening on CO is useful to implement HBV detection and can help to prevent HBVr. Nevertheless, this screening method do not guarantee optimal follow‑up and requires improvements.