Dermatologists' Awareness of and Screening Practices for Hepatitis B Virus Infection Before Initiating Tumor Necrosis Factor-α Inhibitor Therapy

Objective: The aim of the study was to assess dermatologists' awareness of available guidelines and drug package insert information on the screening for and management of hepatitis B (HBV) infection in patients receiving tumor necrosis factor-alpha inhibitor (TNF-alpha I) drug therapies for dermatological disorders. Materials and Methods: An electronic descriptive cross-sectional questionnaire was administered to a random, nationwide sample of physician members of the American Academy of Dermatology. Each participating physician answered 8 questions regarding his or her awareness of the risk of HBV reactivation. Results: More than half of the dermatologists surveyed (52%) were aware of guidelines regarding TNF-alpha I use in dermatological disorders. Dermatologists who were aware of the guidelines performed universal screening 81% of the time versus 3% of those who were unaware. Approximately 30% of the dermatologists were aware of drug manufacturers' package insert warnings for risk of HBV reactivation with TNF-alpha Is. Screening in their high-risk patients was highly variable because >90% performed screening in patients with a history of hepatitis or with elevated liver-associated enzymes. Most (73%) screened appropriately with HB surface antigen. One case of HBV reactivation was observed with infliximab use for psoriasis treatment. Conclusions: Based on this survey, improving education among dermatologists regarding the risks of HBV reactivation and its prevention for patients receiving TNF-alpha I seems warranted. More specific consensus guidelines are recommended to achieve universal screening as the standard of care in these patients.