Prolonged antiviral therapy for hepatitis B virus‐infected health care workers: a feasible option to prevent work restriction without jeopardizing patient safety

Abstract

To prevent transmission of hepatitis B virus (HBV) from health care workers (HCWs) to patients, highly viraemic HCWs are often advised to restrict performing exposure prone procedures (EPPs). To prevent loss of highly qualified medical personnel and simultaneously minimize transmission risk to patients, we offered highly viraemic HCWs antiviral therapy and evaluated the effects of this strategy. Eighteen chronic HBV-infected HCWs have been monitored every 3-6 months for a median period of 5.6 years (range 1.1-12.5 years). Antiviral therapy was offered if HBV DNA was above 10(5) copies/mL and EPPs were performed or active liver disease was present. Median HBV DNA levels, the percentage of days with HBV DNA above 10(3), 10(4) and 10(5) copies/mL, and reduction of HBV DNA during antiviral treatment have been analysed for hepatitis B e antigen (HBeAg)-positive and HBeAg-negative HCWs separately. Prolonged viral suppression was achieved in both HBeAg-positive, as well as HBeAg-negative HCWs. In HBeAg-negative HCWs treatment with interferon or lamivudine maintained HBV DNA levels below 10(5) copies/mL. For HBeAg-positive HCWs continuous treatment with tenofovir or entecavir was essential for reaching low viraemia persistently. In 2004, median HBV DNA levels in both HBeAg-negative and HBeAg-positive HCWs were below 10(3) copies/mL and all HCWs executed their professional work full-range. For both HBeAg-positive and HBeAg-negative HCWs, antiviral treatment is effective in persistent suppression of virus levels below 10(5) copies/mL. This observation supports antiviral therapy as a viable management option instead of work restriction, with the provision of regular expert monitoring including quantification of HBV DNA.

Blood-borne viruses in health care workers: Prevention and management

“…60 However, with the availability of inhibitors of HBV polymerase for chronic HBV infection treatment, HBV DNA may be durably suppressed in HBV-infected HCWs. Thus, as illustrated by Buster et al 61 prolonged antiviral therapy for HBV-infected HCWs is a viable option instead of work restriction, provided that the level of HBV DNA is monitored regularly. This option is also likely to encourage already employed HCWs to determine their status.…”

“…55 Current guidelines concerning prevention of HCW-to-patient transmission of HCV need to be improved. An alternative option to work restrictions for HCV-infected HCWs would be a therapeutic option, 61 which would also incite HCWs to learn their status. In light of the fact that new drugs with increased efficacy will soon be available for patients with chronic hepatitis C, 65 a therapeutic option for HCV-infected HCWs should be strongly encouraged in the near future.…”

Indications for therapy in hepatitis B #

“…Health care workers who test positive for HBsAg, especially those who are HBeAg‐positive and/or have high levels of serum HBV DNA, may be prohibited from working if they are engaged in exposure‐prone procedures 42, 43. It has been suggested that antiviral treatment should be initiated in such cases to allow these workers to return to work 44. This practice has become common in some European countries where health care workers with serum HBV DNA levels below a certain threshold (varying from 3‐5 log 10 copies/mL) are permitted to return to work provided that surveillance testing shows that HBV DNA levels remain suppressed 43.…”

Hepatitis B virus infected health care workers in the Netherlands, 2000-2008

“…More recent HBV inhibitors like entecavir and tenofovir display a much more favourable resistance profile [ 10 , 11 ]. Buster et al have shown that prolonged antiviral therapy for HBV-infected health care workers is a viable option instead of work restriction, provided that the level of HBV DNA is monitored regularly [ 12 ]. Indeed in five cases the ban on EPPs could be lifted, because of successful suppression of HBV.…”