Background: No consensus exists regarding the optimal laboratory screening for hepatitis B infection that should be performed before initiating therapy with tumor necrosis factor-alfa inhibitors or other immunosuppressive agents.
Objective: We sought to give guidelines on which tests to order for hepatitis B screening.
Methods: We review the pathophysiology and serology of hepatitis B infection and provide recommendations for screening for hepatitis B infection in patients with psoriasis before beginning anti-tumor necrosis factor-alfa therapy or other immunosuppressive agents.
Results: We propose the standardized use of triple serology testing: hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody in combination with liver function tests as screening.
Limitations: Conclusions based on review of available literature is a limitation.
Conclusions: All patients with psoriasis who are candidates for tumor necrosis factor-alfa inhibitor should undergo screening for hepatitis B virus infection using the triple serology: hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. It is advisable that patients, who are candidates for ustekinumab, cyclosporine, or methotrexate undergo the same screening.
Keywords: AAD; ALT; American Academy of Dermatology; CDC; Centers for Disease Control and Prevention; CsA; HBV; HBcAb; HBcIgM; HBeAb; HBeAg; HBsAb; HBsAg; HCC; LFT; MTX; TNF; TNFI; alanine aminotransferase; anti–tumor necrosis factor-alfa; biologic therapy; cyclosporine; hepatitis B; hepatitis B core IgM antibody; hepatitis B core antibody; hepatitis B core e antibody; hepatitis B core e antigen; hepatitis B surface antibody; hepatitis B surface antigen; hepatitis B virus; hepatocellular carcinoma; liver function test; methotrexate; psoriasis; tumor necrosis factor; tumor necrosis factor-alfa inhibitor; ustekinumab.
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