HBV Reactivation Risk in IBD on Immunosuppression Algorithm Risk of Reactivation High Risk: >10% Risk • HBsAg+ / HBcAb+ and high dose steroids (pred > 20mg qd for 4 wks), or TNFi* Moderate Risk: 1-10% Risk • HBsAg- / HBcAb+ and TNFi • HBsAg+ / HBcAb+ or HBsAg- / HBcAb+ and Anti-lntegrin or Anti-IL 12/23, or CIN (Tofa?) • HBsAg+ / HBcAb+ and mod dose steroids (pred <10mg qd for 4wks) • HBsAg- / HBcAb+ and high dose steroids Low Risk: <1 % Risk • HBsAg+ / HBcAb + or HBsAg- / HBcAb+ and 6-MP, AZA, MTX • HBsAg+ / HBcAb and short term low dose steroids (pred < 10mg < 1 wk) HBsAg -/HBcAb + and pred < 1 week or <10mg for > 4 weeks Prophylaxis (PPx) • Start before or at the latest at the onset of IS • Continued during entire IS and for 6 months after discontinuation of above IS • Monitor HBsAg, HBVDNA, and LFTs q3mo during PPx and for up to 12mo after d/c PPx Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #HBV #Reactivation #risk #IBD #Immunosuppression #Algorithm #diagnosis #management
