Rheumatologists’ awareness of hepatitis B reactivation before immunosuppressive therapy

  • Bilal TokaEmail author
  • Ahmet Tarik Eminler
  • Emel Gönüllü
  • Mukaddes Tozlu
  • Mustafa Ihsan Uslan
  • Erkan Parlak
  • Oğuz Karabay
  • Aydin Seref Koksal
Observational Research


HBV reactivation (HBVr) is a well-known complication of immunosuppressive (IS) treatment. The aim of this study was to evaluate the awareness of rheumatologists about the risk of HBVr. A survey was sent via e-mail to 270 members of the Turkish Society for Rheumatology. It consisted of fourteen questions on their awareness of the major society guidelines, approach to hepatitis B virus (HBV) screening according to different IS regimens, decision process in screening patients for HBV, knowledge of antiviral treatments for HBV, follow-up strategies, experience and postgraduate training on HBVr. Forty-eight (17.8%) rheumatologists responded to the survey. Of the respondents, 93.8% reported that they screened all patients before IS treatment, while 6.2% screened patients with a high risk of HBV infection only. The screening rate was 95.8% (46/48) in patients undergoing high-risk IS treatment and 35.4% (17/48) in those undergoing low-risk treatment. All respondents screened for HBsAg, and 83.3% (40/48) screened for anti-HBc IgG and anti-HBs. Forty-four (91.7%) rheumatologists had previously initiated antiviral prophylaxis, and 14 (29.2%) had detected HBVr in at least one patient. Rheumatologists had a high awareness of the necessity for HBV screening before IS treatment. However, the screening rates were still lower than desired, especially in patients receiving IS treatments with moderate or low risk of reactivation.


Hepatitis B Reactivation Rheumatology Immunosuppressive treatment 



American association for the study of liver diseases


American College of Rheumatology


American gastroenterology association


Asian Pacific association for the study of the liver


Disease-modifying antirheumatic drugs


The European association for the study of the liver


Hepatitis B virus


Hepatitis B virus reactivation


Statistical package for social sciences


Turkish society for rheumatology


United States of America


Author contributions

Conception or design of the work: BT, ATE, EG, MT, MIU, EP, OK, ASK. Data collection: BT, ATE, EG, MT, MIU and ASK. Data analysis and interpretation: BT, ATE, EG, EP, OK, ASK. Drafting the article: BT, ASK. Critical revision of the article: BT, ATE, EG, EP, OK, ASK. Final approval of the version to be published: BT, ATE, EG, MT, MIU, EP, OK, ASK. All authors approved the final manuscript as submitted. All co-authors take full responsibility of the integrity of the study and all parts of the manuscript.


The study was funded by the authors.

Compliance with ethical standards

Conflict of interest

Author Toka B., Author Eminler A. T., Author Gönüllü E., Author Tozlu M., Author Uslan M. I., Author Parlak E., Author Karabay O. and Author Köksal A. Ş. have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, Faculty of MedicineSakarya UniversitySakaryaTurkey
  2. 2.Department of Rheumatology, Faculty of MedicineSakarya UniversitySakaryaTurkey
  3. 3.Department of Infectious Diseases, Faculty of MedicineSakarya UniversitySakaryaTurkey

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