Background/Purpose: Intravenous immunoglobulin (IVIG) is a blood product created by pooling of donor plasma that is used for a wide range of indications. IVIG is commonly used in the fields of neurology, rheumatology, hematology, and transplant medicine. Previous studies have identified transient positivity of hepatitis B core antibody (HBcAb) after receiving IVIG. This phenomenon signifies a passive transference of HBcAb from IVIG as opposed to a previous exposure to HBV. This study examines the clinical consequences of this concept, including the inappropriate administration of antiviral therapy and the deferment of immunotherapy, such as anti-CD20 monoclonal antibodies, in fear of HBV reactivation.

Methods: Preliminary database search identified patients that were at least 18 years of age, tested HBcAb-positive, and received IVIG between January 2013 through January 2021. After exclusion criteria were applied, retrospective chart review was performed to determine the indication for IVIG, whether patients received antiviral therapy, and whether they received an anti-CD20 monoclonal antibody (rituximab, ocrelizumab, or ofatumumab).

Results: Preliminary search yielded 123 patients that met inclusion and exclusion criteria. Of these 123 patients, 37 (30.1%) tested HBcAb-negative before IVIG, tested HBcAb-positive after IVIG, and had undetectable HBV DNA levels (see Figure 1). Indications for IVIG included pathologies in hematology, immunology, neurology, rheumatology, and transplant medicine (see Figure 2). These patients represent confirmed false-positives for HBcAb. Of these 37 patients, 22 (42.3%) received antiviral therapy (either tenofovir or entecavir). 29 (78.4%) did and 8 (21.6%) did not receive anti-CD20 monoclonal antibody therapy.

Conclusion: This study demonstrates that a significant portion of patients receive unnecessary antiviral therapy due to the passive transfer of HBcAb with IVIG. This leads to an inappropriate utilization of resources and potential exposure to side effects of the medication. This study also highlights a proportion of patients that do not receive anti-CD20 monoclonal antibody therapy, which may be related to HBcAb-positivity. As previous studies have suggested, HBV testing should be done prior to IVIG administration in order to establish an accurate HBV status for the patient. In doing so, patients may avoid unnecessary prescription of antiviral therapy. Furthermore, physicians would have a clear understanding of the actual risk of HBV reactivation when considering the use of anti-CD20 monoclonal antibodies.

Flow Chart.jpeg”Figure 1: Flowchart of Retrospective Analysis

Figure 2: Indications for IVIG

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-consequences-of-hepatitis-b-core-antibody-positivity-after-ivig-administration/