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Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement
Author(s) -
Doyle Joseph,
Raggatt Michelle,
Slavin Monica,
McLachlan SueAnne,
Strasser Simone I,
Sasadeusz Joseph J,
Howell Jessica,
Hajkowicz Krispin,
Nandurkar Harshal,
Johnston Anna,
Bak Narin,
Thompson Alexander J
Publication year - 2019
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50160
Subject(s) - medicine , entecavir , hepatitis b virus , hepatitis b , hbsag , context (archaeology) , immunosuppression , cancer , immunology , intensive care medicine , lamivudine , virus , paleontology , biology
Individuals with chronic hepatitis B virus ( HBV ) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia. Main recommendations Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [ HB sAg], HBV core antibody [anti‐ HB c], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection ( HB sAg positive) or past exposure ( HB sAg negative and anti‐ HB c positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir. Changes in management as a result of this statement This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.