The use of words like “must,” “must not,” “should,” and “should not” indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In this study, 83 HBsAg-negative and anti-HBc–positive patients with a hematologic malignancy receiving anti-CD20 therapy were followed with frequent laboratories every 4 weeks without antiviral therapy. The risks vary according to patient factors (eg, immune competence, sex, age, family history), viral factors (eg, viral load, genotype), as well as environmental factors (eg, concurrent viral infections, alcohol use, metabolic syndrome).11 Patients with hematologic malignancies and chronic HBV are at high risk of HBV reactivation (approximately 50%) and associated adverse liver outcomes, and, as such, they should receive antiviral prophylaxis to prevent HBV reactivation.17,27,28 Similarly, patients with HCC due to underlying chronic HBV should be continued or treated with antiviral therapy due to the high risk of reactivation—up to 30% after various systemic anticancer therapies including combined chemoradiation.29,30 Antiviral therapy also reduces the risk of HCC recurrence after potentially curative HCC therapy. Tests that can help diagnose hepatitis B or its complications are: 1. Epub 2017 Sep 28. The following represents disclosure information provided by authors of this manuscript. Hepatitis B Virus Screening Expert Panel Membership. Notably, 2 panel members in 2015 offered a minority viewpoint, namely, a strategy of universal HBsAg and selective anti-HBc testing. Awareness of these disparities in access to care should be considered in the context of this clinical practice guideline, and health care providers should strive to deliver the highest level of cancer care to these vulnerable populations. Response categories of “Agree as written,” “Agree with suggested modifications,” and “Disagree. Racial and ethnic disparities in health care contribute significantly to this problem in the United States. In 2010, ASCO published a Provisional Clinical Opinion (PCO) on hepatitis B virus (HBV) infection screening in patients receiving anticancer therapy for the treatment of malignant diseases. Vaccination can be recommended, taking into consideration a patient’s clinical situation and timing.
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. ASCO’s first PCO on this topic in 2010 recommended that clinicians consider screening patients belonging to groups at heightened risk for chronic HBV infection or if highly immunosuppressive therapies, such as rituximab or stem-cell transplantation, were planned.1 In 2015,2 ASCO’s updated PCO recommended that clinicians test patients for HBV infection before starting anti-CD20 therapy or stem-cell transplantation and that providers also test patients with risk factors for HBV infection. Serologic testing for Hepatitis B surface antigen (HBsAg) is the primary way to identify persons chronic HBV infection. Reprint requests: 2318 Mill Rd, Suite 800, Alexandria, VA 22314; [email protected]org. Among patients with past HBV, if the anti-HBs is positive, then this is considered resolved HBV infection; if the anti-HBs is negative, then this is considered isolated anti-HBc–positive. In another prospective study, Hwang et al3 explored a broader set of HBV risk factors in a study of 2,124 patients with a hematologic malignancy or a solid tumor awaiting systemic anticancer therapy over a 17-month period during 2013-2014 in Houston, Texas. A positive anti-HBs alone (with negative HBsAg and anti-HBc) indicates vaccine-induced protective immunity and would not require further testing or management. Am J Gastroenterol 111:1788-1795, 2016 [Erratum: Am J Gastroenterol 111:1858, 2016], US Preventive Services Task Force, Owens DK, Davidson KW, et al: Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. Many other patients lack access to care because of their geographic location and distance from appropriate treatment facilities. All members of the Expert Panel completed ASCO’s disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline. Interpretation of HBV Test Results. Cancer.Net, ASCO.org In addition, patients with past HBV, especially those who are not receiving anti-CD20 therapy or stem-cell transplantation, have a lower risk of HBV reactivation than those with chronic HBV; studies should be conducted to elucidate optimal clinical care paths for these patients. Evid Rep Technol Assess (Full Rep). This information does not mandate any particular course of medical care. Absent evidence from RCTs on the comparative utility of risk-based HBV screening versus universal screening strategies or on the predictors of HBV reactivation, especially the risk caused by a myriad of anticancer therapies, the Panel outlined several clinical considerations to support and amplify the recommendations offered in the PCO and associated clinical algorithm (Fig 1). FIG 1. Using bootstrapping methods, the investigators developed various models to determine the most efficient number and type of HBV risk questions to minimize the false-negative rate so that patients with HBV would not be missed, as this would be potentially devastating after anticancer therapy. Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more. The targeted literature search conducted for this cost section yielded 59 abstracts, of which 6 were considered relevant to the topic of HBV screening and management in patients with cancer anticipating systemic anticancer therapy.63-68 Excluded from consideration by ASCO are cost-effectiveness analyses that lack contemporary cost data and agents that are not currently available in the United States and/or are industry sponsored. European Association for the Study of the Liver. Patients who are negative for all HBV screening tests (negative HBsAg, anti-HBc, and anti-HBs) are considered not to be immune to HBV, have never been exposed to HBV, and may benefit from HBV vaccination,14 taking into consideration a patient’s clinical situation and timing of anticancer therapy. Accounting for these factors will promote shared decision making. Most published efforts use electronic health records (EHR). Past HBV infection refers to patients who have a negative HBsAg with positive anti-HBc, regardless of anti-HBs status; HBV DNA is usually undetectable. A number of blood tests are available to diagnose and monitor people with hepatitis B. It is believed that such replication is inhibited by a host’s strong immune control, and thus HBV reactivation occurs only with potent immunosuppression. Archive Hepatitis D is a defective virus that requires hepatitis B to replicate and is only found with hepatitis B co-infection. Of concern is the recent signal of potential complications from HBV after checkpoint blockade immunotherapy. Hepatitis flares, presenting as elevated ALT levels, can occur after the discontinuation of antiviral therapy. July 27, 2020. DOI: 10.1200/JCO.20.01757 Journal of Clinical Oncology
and A.S.A. We have described the patient population at risk for HBV reactivation in the 2015 PCO.2 In brief, HBV reactivation has been well characterized among patients with HBV with a hematologic malignancy, where the risk of reactivation ranges from 48% among patients with chronic HBV to 18% among those with past HBV.35,36 HBV reactivation has been studied less frequently among patients with HBV with a solid tumor,37 where the risk of reactivation has been estimated to be approximately 25% among those with chronic HBV and 3% among those with past HBV. Epub 2020 Oct 9. As such, ALT levels should be monitored frequently, at least monthly for the first 3 months after the cessation of antiviral therapy and every 3 months thereafter (Type: informal consensus, benefits outweigh harms; Strength of recommendation: strong). ASCO PCOs are updated by an Expert Panel on the basis of periodic review and analysis of new information on the topic. In our PCO (Fig 1), we use a simplified cut-off threshold of HBV DNA > 1,000 IU/mL to assist and guide oncology providers with respect to the threshold above which further management is warranted in patients with past HBV infection. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. I = Immediate Family Member, Inst = My Institution. Screening for hepatitis B virus infection: Are we asking the right questions? Patients with chronic HBV receiving any systemic anticancer therapy should receive antiviral prophylactic therapy for the duration of anticancer therapy, as well as for at least 12 months after receipt of the last anticancer therapy. Meeting Abstracts, About Some people with hepatitis B are sick for only a few weeks (known as “acute” infection), but for others, the disease progresses to … Hepatitis B blood tests detect viral proteins (antigens), the antibodies that are produced in response to an infection, or detect or evaluate the genetic material (DNA) of the virus. Hepatitis B virus (HBV) is a partly double-stranded DNA virus that causes acute and chronic liver infection. We lack evidence in patients with MCC. A special ultrasound called transient elastography can show the amount of liver damage. In another study of 965 patients with cancer at a single hospital in Taiwan from 2011 to 2012 who received systemic anticancer therapy and were not previously screened for HBV, a computer-assisted system was used to send reminders to oncology providers to order HBsAg testing prior to ordering anticancer therapy and, if the test was positive, to start antiviral therapy and refer to hepatology.26 HBV screening increased from a baseline of 8% to an overall rate of 86% (825/965), without significant differences according to cancer type. Among patients with past HBV (prevalence, 6.5%; 197/3,050), 27% (n = 54) had no known HBV risk factors. A search for new evidence on HBV screening in individuals with cancer was conducted to identify relevant studies published since the 2015 ASCO PCO. Testing for HBsAg now is recommended for: persons born in geographic regions with HBsAg prevalence of ≥ 2% US born persons not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of ≥8% However, the specificities of the brief tools were low (< 15%), likely due to the high prevalence of having at least one of the significant risk variables in the models—for instance, 76% of the participants were > 50 years of age. Negatives HBs-Ag schließt eine Hepatitis D aus, da das Hepatitis-D-Virus nur zusammen mit dem Hepatitis-B-Virus auftreten kann. The draft statements were released to the public for open comment from February 10, 2020, through February 24, 2020. In 2019, Ramsey et al8 published a study of HBV, hepatitis C virus (HCV), and HIV screening among 3,051 patients with a hematologic malignancy or a solid tumor awaiting any anticancer therapy over a nearly 42-month period of time during 2013-2017 among 18 institutions within the SWOG Cancer Research Network, a member of the National Clinical Trials Network. In contrast, for lower-risk anticancer therapies—likely most standard solid tumor regimens—the reactivation risk may be very low and surveillance or antiviral therapy may not be required. Follow-up testing after the cessation of anticancer therapy is likely not necessary (Type: informal consensus, benefits outweigh harms; Strength of recommendation: strong). For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center. The Hep B Blood Tests There are 3 hep B tests called HBsAg, anti-HBs, and anti-HBc. As such, anti-HBc testing after IVIG should be interpreted with caution. Patients with a negative anti-HBs may be at higher risk of HBV reactivation than patients who have a positive anti-HBs. Administrative support: Mark R. Somerfield, Collection and assembly of data: Jessica P. Hwang, Mark R. Somerfield, Andrew S. Artz, Data analysis and interpretation: All authors, Final approval of manuscript: All authors, Accountable for all aspects of the work: All authors. (†) Past HBV: HBsAg-negative, anti-HBc–positive, regardless of anti-HBs status. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or Patients who are positive for anti-HBc and anti-HBs have resolved hepatitis B infection and should be counseled that they are at risk, albeit lower than if they had a negative anti-HBs, of HBV reactivation. Antiviral therapy and management for these patients should follow national HBV guidelines, independent of cancer therapy, including management by a clinician experienced in HBV management for prevention of liver disease such as cirrhosis or liver cancer. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. PCOs are updated periodically based on review of recently published data. JAMA [epub ahead of print on March 2, 2020], 2318 Mill Road, Suite 800, Alexandria, VA 22314, © 2020 American Society of Clinical Oncology. J Gastroenterol Hepatol. However, operationalizing such an alternative, universal HBV screening strategy may be difficult. Participants completed a survey about viral risk factors drawn from the National Health Interview Survey and the Centers for Disease Control and Prevention (CDC) and had serologic testing for HBV, HCV, and HIV. Jourdain G, Ngo-Giang-Huong N, Cressey TR, Hua L, Harrison L, Tierney C, Salvadori N, Decker L, Traisathit P, Sirirungsi W, Khamduang W, Bowonwatanuwong C, Puthanakit T, Siberry GK, Watts DH, Murphy TV, Achalapong J, Hongsiriwon S, Klinbuayaem V, Thongsawat S, Chung RT, Pol S, Chotivanich N. BMC Infect Dis. 2016 Aug 9;16:393. doi: 10.1186/s12879-016-1734-5. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST. 19. Hepatitis B is a liver infection caused by the hepatitis B virus. NYU Langone doctors provide screening for hepatitis B and hepatitis C, two forms of hepatitis that can become chronic and lead to serious liver damage without treatment. The three major tests used for hepatitis B screening are HBsAg, anti-HBs, and anti-HBc. doi: 10.1046/j.1440-1746.17.s1.3.x. Universal HBV screening before the start of anticancer therapy for patients with solid tumors was found to be cost effective in analyses conducted by Konijeti et al65 and by Wong et al67 but not cost effective in analyses conducted by Hwang et al63 and Tan et al.66 Additional research is needed on HBV screening to address cost effectiveness more definitively, particularly in patients with solid tumors for whom adequate data on the reactivation risk of commonly used anticancer treatments are lacking. (November 01, 2020)
Since the Panel’s 2015 PCO,2 there has been a series of informative and independent studies to clarify the optimal HBV screening approach. ASCO Meetings The involvement of general practitioners in the early detection of viral hepatitis B and C must be paramount. Similarly, CD19 chimeric antigen receptor T cells (CAR-T) represent a unique high-risk group based on biology that aims to cause B-cell aplasia. Clipboard, Search History, and several other advanced features are temporarily unavailable. An alternative approach to screening using both HBsAg and anti-HBc tests would be to advise HBsAg testing in all patients with cancer, regardless of treatment regimen, and to limit anti-HBc testing to those receiving cancer therapy for which there is an appreciable risk of reactivation, thus requiring surveillance and/or antiviral therapy. To further complicate matters, patients with cancer who receive IVIG usually have a hematologic malignancy and could also be receiving anticancer therapies that pose a high risk of HBV reactivation, such as B cell–depleting strategies or stem-cell transplantation. Controlled vocabulary supplemented with key words was used to search Ovid Medline, Ovid Embase, and PubMed from January 2009 through January 2020 (Data Supplement). Multi-agent regimens, varied duration of therapy, and effects of prior lines of therapy preclude precise estimates of HBV reactivation, as the risk by drug or class would be unclear. In 2015, Brasseur et al18 published a study of 388 patients with a solid tumor who completed a brief survey about potential risks for HBV infection—including birth place in high HBV-prevalence area, drug use, and transfusions, among others—and who had HBV testing over a 14-month period of time during 2012-2013 in Reims, France. Safety and efficacy of REP 2139 and pegylated interferon alfa-2a for treatment-naive patients with chronic hepatitis B virus and hepatitis D virus co-infection (REP 301 and REP 301-LTF): a non-randomised, open-label, phase 2 trial. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. 2. JCO OP DAiS, ASCO eLearning Hepatitis flares, presenting as elevated ALT levels, can occur after the discontinuation of antiviral therapy. | Even if HBV treatment is not indicated during their cancer treatment, it is important for them to receive ongoing care for their HBV, including assessment for long-term antiviral therapy based on standard HBV guidelines and evaluation for HCC screening. [16] In adults, hepatitis B infection is most commonly self-limiting, with less than 5% progressing to chronic state, and 20 to 30% of those chronically infected developing cirrhosis or … J Hepatol. Enter words / phrases / DOI / ISBN / authors / keywords / etc. There is a simple blood test to diagnose a hepatitis B infection. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation, such as anti-CD20 monoclonal antibodies or stem-cell transplantation, should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after the cessation of anticancer therapy. See Table 3 for details of the HBV conditions based on screening test results. Patients with past HBV undergoing other systemic anticancer therapies not clearly associated with a high risk of HBV reactivation should be monitored with HBsAg and alanine aminotransferase during cancer treatment; antiviral therapy should commence if HBV reactivation occurs. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy. Increasingly, individuals with cancer are required to pay a larger proportion of their treatment costs through deductibles and coinsurance.58,59 Higher patient out-of-pocket costs have been shown to be a barrier to initiating and adhering to recommended cancer treatments.60,61 Discussion of cost can be an important part of shared decision making.62. Hwang et al3 conducted a large prospective observational cohort study of 2,124 patients with cancer to develop various HBV screening strategies prior to the initiation of systemic anticancer therapy. However, the 2015 updated PCO highlighted that current evidence at that time was insufficient to support HBV testing for patients who had neither HBV risk factors nor anticipated anticancer therapy that was not associated with a high risk of reactivation. Important factors to consider are if concurrent medical conditions further amplify HBV reactivation risks (eg, immunosuppression for other conditions), drug interactions with antiviral therapy, and patient goals. Patients with cancer who are members of racial/ethnic minorities suffer disproportionately from comorbidities such as HBV infection and could experience more substantial obstacles to receiving care. Hepatitis B screening in non -pregnant, high-risk individual includes hepatitis B surface antigen (HBSAG), antibodies to HBSAG (anti-HBS) and antibodies to hepatitis B core antigen (anti … Acute hepatitis B refers to the early part of the infection when the virus is newly acquired. 2014;161(1):58-66. Patients with past HBV undergoing anticancer therapies that are not clearly associated with a high risk of HBV reactivation (eg, regimens that do not include anti-CD20 monoclonal antibodies or stem-cell transplantation) should be followed carefully during cancer treatment, with HBsAg and ALT testing every 3 months (with subsequent HBV DNA testing if a hepatitis flare develops) with initiation of antiviral therapy only if HBsAg becomes positive or HBV DNA exceeds 1,000 IU/mL in the setting of a hepatitis flare. | Articles were excluded from the review if they were (1) meeting abstracts not subsequently published in peer-reviewed journals; (2) editorials, commentaries, news articles, case reports, narrative reviews, or studies of children; and (3) published in a non-English language. Advertisers, Journal of Clinical Oncology Patient information is available at www.cancer.net. Biosensing based on field-effect transistors (FET): Recent progress and challenges. For recommendations and strategies to optimize patient-clinician communication, see Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline.57 Communication topics of particular relevance to HBV screening and management are briefly discussed below: Patients should be informed of their HBV testing results.
It is important to test for HIV prior to starting entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide in patients with HBV, since these medications have anti-HIV properties, and HIV monotherapy is not recommended for patients with HIV. Key elements of the 2020 HBV Update are listed below and in Figure 1. Ann Intern Med. We thank Jeremy Kortmansky, MD, and Dorinda Sparacio and the Clinical Practice Guidelines Committee for their thoughtful reviews and insightful comments on this Provisional Clinical Opinion (PCO). Newly diagnosed patients receiving anticancer therapy. Patients with past HBV undergoing anticancer therapies that are not clearly associated with a high risk of HBV reactivation (eg, regimens that do not include anti-CD20 monoclonal antibodies or stem-cell transplantation) should be followed carefully during cancer treatment, with HBsAg and ALT testing every 3 months (with subsequent HBV DNA testing if a hepatitis flare develops), with initiation of antiviral therapy only if HBsAg becomes positive or HBV DNA exceeds 1,000 IU/mL in the setting of a hepatitis flare. However, because these patients have not been well studied, large randomized studies are needed to determine optimal management strategies. Table 4 summarizes the methods and results of the 6 cost-effectiveness analyses identified by the targeted literature search.
Coordination of care with a clinician experienced in HBV management is highly recommended for patients with chronic HBV, especially to monitor for withdrawal flares, determine monitoring and antiviral therapy after the cessation of anticancer therapy, and evaluate for advanced liver disease such as cirrhosis or liver cancer (Type: informal consensus, benefits outweigh harms; Strength of recommendation: strong). Hepatitis flares, presenting as elevated ALT levels, can occur after the discontinuation of antiviral therapy. They can be used to distinguish acute and chronic infections.Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B surface antigen HBsAg. Should their anticancer treatment regimen change beyond hormonal therapy alone, the risk of HBV reactivation based on their new anticancer therapy should be reassessed (Type of recommendation: informal consensus, benefits outweigh harms; Strength of recommendation: moderate). Studies of patients with solid tumors, by contrast, at lower risk of HBV reactivation due to the treatments received, have been less consistent. Patients with past HBV infection undergoing anticancer therapies associated with a high risk of HBV reactivation, such as anti-CD20 monoclonal antibodies or stem-cell transplantation, should receive antiviral prophylaxis during and for minimum 12 months after anticancer therapy completion, with individualized management thereafter. Red cell distribution width-to-lymphocyte ratio: A novel predictor for HBV-related liver cirrhosis. These comments were taken into consideration while finalizing the opinion. 2017 Dec;2(12):877-889. doi: 10.1016/S2468-1253(17)30288-1. In Singapore, Hepatitis B screening with HBsAg, anti-HBs and anti-HBc, consultation and immunisation in a primary care subsided setting cost USD$65, USD$8 and USD$40 respectively. Systems-based approaches have been used to address barriers to the implementation of universal HBV screening in primary care populations. Chronic HBV infection refers to patients who are HBsAg-positive regardless of anti-HBc status, although most will be anti-HBc–positive. Finally, we thank Brittany Harvey for her assistance with the manuscript preparation, review, and editing. Epub 2017 Apr 18. Zhang X, Wang D, Chen Z, Guo N, Wang W, Xiong C, Liu J, Yue Y, Sun M. Medicine (Baltimore). This Provisional Clinical Opinion update presents a clinically pragmatic approach to hepatitis B virus (HBV) screening and management. Owens DK, Davidson KW, Krist AH, et al Creating evidence-based recommendations to inform treatment of patients with additional chronic conditions, a situation in which the patient may have ≥ 2 such conditions—referred to as multiple chronic conditions (MCC)—is challenging. Chronic hepatitis B is defined as the persistence of hepatitis B surface antigen for more than six months. Currently, there is a lack of data to accurately ascertain the risk of HBV reactivation by anticancer class or specific drug, apart from the established high risk after anti-CD20 monoclonal antibodies or stem-cell transplantation. Patients with a negative anti-HBs may be at higher risk of HBV reactivation than patients who have a positive anti-HBs. 2008. Individuals who are negative for HBsAg and anti-HBc, as well as anti-HBs, have never been exposed to HBV, are not immune, and thus are susceptible to HBV infection. More information, including a supplement with additional evidence tables, slide sets, and clinical tools and resources, is available at www.asco.org/supportive-care-guidelines. In 2004, US FDA recommended HBV screening of high risk patients before the first Rituximab infusion and treatment of patients with positive hepatitis B surface antigen or antibody to hepatitis B core. For B cell–modulating agents such as Bruton tyrosine kinase inhibitors (eg, ibrutinib), cases of HBV reactivation have been reported, but the degree of risk has not yet been clearly established.46,47, The decision for oncologists to screen aging patients with cancer who are debilitated or frail and whose life expectancy is limited warrants consideration of risks and benefits of screening and antiviral therapy. Routine screening for hepatitis B is not currently recommended in France. The PubMed database was searched from January 2014 to January 2020 (Data Supplement). Anticancer therapy should not be delayed for the results of these screening tests. Members of the Expert Panel were responsible for reviewing and approving the penultimate version of the PCO, which was then circulated for external review and submitted to Journal of Clinical Oncology for editorial review and consideration for publication. TABLE 1. 38, no. Medical oncologists, hematologists, oncology nurses, oncology pharmacists, and other health care professionals who care for patients with cancer, and patients with cancer. These persons include those … 2017 Aug;67(2):370-398. doi: 10.1016/j.jhep.2017.03.021. Newest Articles Conquer Cancer Foundation This site needs JavaScript to work properly. We assessed prenatal screening uptake and prevalence of prenatal hepatitis B surface antigen (HBsAg) from 2012 to 2016, as well as subsequent hepatitis B e-antigen (HBeAg) and HBV DNA testing and percent positivity. Follow-up testing after the cessation of anticancer therapy is likely not necessary (Type of recommendation: informal consensus, benefits outweigh harms; Strength of recommendation: strong). Subscribers HHS The risk of HBV reactivation among patients with solid tumors—who make up the majority of patients with cancer—is very likely lower than for patients with hematologic malignancies. anti-HBs or HBsAb (Hepatitis B surface antibody) - A "positive" or "reactive" anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). A universal HBV screening strategy would be aligned with national universal screening guidelines for HCV55and for HIV.56 Furthermore, universal HBV screening before anticancer therapy may ultimately be pre-empted by universal population-based HBV screening and management. tests—hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen (anti-HBs)—prior to, or at the beginning of, systemic anticancer therapy. Medical experts and public health agencies opinions can differ All patients anticipating systemic anticancer therapy should be tested for HBV by 3 tests—hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen—but anticancer therapy should not be delayed.
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