[Interpretation of tuberculosis and hepatitis screening before immunosuppressive treatment]

Area of Science:

• Infectious Diseases
• Immunology
• Hepatology

Background:

• Unrecognized latent tuberculosis infection (LTBI) poses a life-threatening risk of reactivation under immunosuppressive therapy.
• Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections can lead to severe complications, including liver cirrhosis, during immunosuppression.

Purpose of the Study:

• To outline diagnostic and screening strategies for LTBI, HBV, and HCV in patients undergoing immunosuppressive therapy.
• To emphasize the importance of early detection and management to mitigate risks associated with these infections.

Main Methods:

• LTBI diagnosis involves patient history, physical examination, interferon-gamma release assay (IGRA), and chest X-ray to exclude active tuberculosis.
• HBV screening includes HBsAg and anti-HBc to identify high-risk carriers requiring antiviral prophylaxis and serologically resolved infections.
• HCV screening utilizes anti-HCV antibodies for detection, enabling successful interferon-free antiviral treatment.

Main Results:

• Established LTBI therapies reduce reactivation risk by approximately 80%.
• HBV screening reliably differentiates high-risk carriers needing prophylaxis from those with resolved infections.
• HCV can be detected and treated effectively with antivirals, preventing progression to liver cirrhosis.

Conclusions:

• Comprehensive screening for LTBI, HBV, and HCV is essential prior to initiating immunosuppressive therapy.
• Timely diagnosis and appropriate management significantly reduce the risk of severe outcomes and improve patient prognosis.
• Antiviral therapies for HBV and HCV are effective in preventing reactivation and complications during immunosuppression.