HOW GOOD A JOB ARE WE RHEUMATOLOGISTS DOING IN SCREENING FOR HEPATITIS B & C BEFORE INITIATING IMMUNO-SUPPRESIVE/S IN SLE ?

Purpose:  Use of immunosuppressive medications (ISM) can potentially exacerbate underlying Hepatitis B & C. Most Systemic Lupus Erythematosus (SLE) patients require ISM. Various organizations (CDC, AASLD, ACR, EASL, BAD, ECCO*) have poorly defined guidelines for Hepatitis B/C screening. We sought to quantify the prevalence and correlates of Hepatitis B and C screening among SLE patients on ISM.

Method:  Retrospective chart review of 100 SLE patients receiving ISM and followed in the outpatient rheumatology clinics was done. Data included demographics, total number, name and current dose of ISMs being currently used, and whether Hepatitis B and C screening was performed prior to ISM initiation. ISM use was defined as current use of any ISM including corticosteroids. Significant ISM use was defined as current use of prednisone ≥7.5 mg/day along with another ISM  other than Hydroxychloroquine. Chi square test was used to compare discrete variables, while t tests were used to compare continuous variables. 

Result:  86% were women; mean (SD) age was 27.9 ± 4 yrs.  Forty percent of patients were taking one ISM, 41 % two, 19% three ISM’s. Nearly half of the patients were on corticosteroids (CS) with a median dose of 5 mg/day. Hepatitis B & C screening tests were performed in 34% and 33% patients respectively. All the patients tested for Surface Antigen (HBS Ag) were negative. Of those tested, 12/29 had Hepatitis Surface Antibody (HBS Ab), 2/29 Hepatitis B core Antibody (HBc Ab) & 1/33 had Hepatitis C antibody (HCV Ab). Screening tests were offered more frequently to younger patients, those on ≥ one ISM, those on steroids, or those on significant ISM.

Among SLE patients on significant ISM, 47% were screened for HBS Ag, as compared to 22% of patients not on significant ISM (p=0.007). Likewise, 47% on significant ISM were screened for HCV Ab as compared to 20% not on significant ISM (p=0.004).

Conclusion:   Hepatitis B & C screening rates are low and range from 30-50% in patients receiving ISM in SLE (< 40 %). These results are from an academic facility, thus may be an overestimation of prevalent screening rates among SLE patients in the community. Our results indicate opportunities to improve screening. Education of physicians and harmonization of various recommendations on Hepatitis B and C screening is indicated.