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Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration

World Journal of Gastroenterology 2016年第19期22卷 4732-4740页

作者： Christine M Hunt lauren a beste Elliott Lowy Ayako Suzuki Cynthia A Moylan Hans L Tillmann George N Ioannou Joseph K Lim Michael J Kelley Dawn Provenzale Department of Medicine Duke University School of Medicine Durham NC 27710 United States Department of Medicine Durham VA Medical Center Durham NC 27705 United States Department of Medicine Veterans Affairs Puget Sound Health Care System Seattle WA 98108 United States Health Services Research and Development Veterans Affairs Puget Sound Health Care System Seattle WA 98108 United States Department of Medicine University of Washington Seattle WA 98195 United States University of Washington School of Public Health Seattle WA 98195 United States Department of Medicine University of Arkansas for Medical Sciences Little Rock AR 72205 United States Division of Hepatology Central Arkansas Veterans Heathcare System Little Rock AR 72205 United States Department of Medicine Eastern Carolina University Greenville NC 27858 United States Yale Liver Center Section of Digestive Diseases Yale University School of Medicine New Haven CT 06520 United States Office of Patient Care Services Department of Veterans Affairs Washington DC 20420 United States Hematology-Oncology Service Durham Veterans Affairs Medical Center Durham NC 27705 United States Cooperative Studies Program Epidemiology Center-Durham Durham Veterans Affairs Medical Center Durham NC 27705 United States Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC 27710 United States

AIM: To evaluate pretreatment hepatitis B virus(HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality ***: We performed a retrospective cohort study using a national repository of Veterans Health Administration(VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment(2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status(from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during antiCD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV(hepatitis B surface antigen positive or HBs Ag+), past HBV(HBs Ag-, hepatitis B core antibody positive or HBc Ab+), resolved HBV(HBs Ag-, HBc Ab+, hepatitis B surface antibody positive or HBs Ab+), likely prior vaccination(isolated HBs Ab+), HBV negative(HBs Ag-, HBc Ab-), or unknown. Acute hepatitis B was defined by the appearance of HBs Ag+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ2 test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease ***: Among 19304 VHA patients who received anti-CD20 Ab, 10224(53%) had pretreatment HBs Ag testing during the study period, with 49% and 43% tested for HBs Ag and HBc Ab, respectively within 6 mo pretreatment in 2014. Of those tested, 2%(167/10224) had chronic HBV, 4%(326/7903) past HBV, 5%(427/8110) resolved

关键词： Hepatitis B Hepatitis B reactivation AntiCD20 antibody Rituximab Lymphoma Chemotherapy Hepatitis B a

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