Background/Purpose:
Hepatitis B & C
viral infections are widely prevalent and the potential of immunosuppressive
medications (ISM) to exacerbate an underlying viral infection is well reported.
Established guidelines are poorly defined regarding Hepatitis B and C screening
prior to initiation of ISM, and may result in (a) physician practice
variations, (b) missed opportunities for optimal health care and outcomes, and
(c) complicate management plans for patients in need of ISM. We sought to
better understand existing practices for viral hepatitis screening, and study
the prevalence and correlates of Hepatitis B and C screening among Systemic
Lupus Erythematosus (SLE) patients on ISM.

Methods: We conducted a retrospective chart review
of 100 SLE patients receiving ISM and being followed in outpatient rheumatology
clinics. Data collected included demographics, total number, name and current
dose of ISMs being currently used, and if testing (and results) for Hepatitis B
and C was ordered prior to ISM initiation. ISM use was defined as current use
of any ISM including corticosteroids (CS). Significant ISM use was defined as
current use of prednisone > 7.5 mg/day along with an ISM other than hydroxychloroquine. Descriptive statistics were obtained.
Chi square test were used to compare discrete variables, while t tests were
used to compare continuous variables. Mann –Whitney test was used when
data was not normally distributed. P value < 0.05 was considered significant
on two tailed tests.

Results: 86% were women and the mean (SD) age was
27.9 ± 4 years. Forty one percent of patients were taking one ISM, 41% were on
two and 19% were on three ISMs’. Nearly half of the patients were on 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 Hepatitis B
Surface Antigen (HBS Ag) were negative. Of those tested, 12/29 had Hepatitis B
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 more than one
ISM, those on CS and those on significant ISM. Among those
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: Less than 40% of those on ISM received
Hepatitis B & C screening in SLE. Less than half of SLE patients that
were tested prior to ISM showed immunity against Hepatitis B virus.
 Nearly 7% of SLE patients tested for Hepatitis B before ISM, showed
chronic Hepatitis B, while 3% of SLE patients tested positive for Hepatitis C
virus before ISM. These results indicate opportunities to improve screening and
detect Hepatitis B/C in SLE patients on ISM. Education of physicians treating
patients at higher risk and harmonization of various recommendations on
Hepatitis B and C screening is indicated.