N28 Effectiveness of pre-biologic screening for viral hepatitis and HIV

Background

Biologic treatments can reactivate viral hepatitis and HIV. Prior to starting biologic therapy, the ECCO guidelines recommend patients are screened for chronic viral infection. We recently diagnosed a patient treated with adalimumab with HIV. As a consequence we sought to assess the effectiveness of our screening process for viral infections and to identify factors linked to non-testing

Methods

We screened our pharmacy dispensing records and IBD database for all patients currently treated with biologic therapies. We then cross-referenced our virology records for HIV, Hepatitis B (HBV) and Hepatitis C (HCV) screening. We used our IBD database and clinical records to record demographic and clinical factors associated with non-testing.

Results

As of September 2019 we were treating 453 patients with a biopharmaceutical drug in whom pre-treatment testing for viral hepatitis and HIV is recommended. Amongst whom, 50 (11%), 22 (5%) and 24 (5%) patients had not been tested for HIV, HBV or HCV, respectively.

Our patient with HIV had inflammatory ileocolonic Crohn’s disease and been treated with combination azathioprine and adalimumab since October 2016. He was in clinical remission at the time of HIV diagnosis (July 2018). We stopped his azathioprine and adalimumab and he was commenced on antiretroviral therapy. After 13 months’ follow-up, he had not developed immune reconstitution syndrome or had a flare of his Crohn’s disease. Moving forwards, the identified unscreened patients currently on biologic treatment are being tested at the earliest opportunity. Patients receiving infusions of biopharmaceuticals are being screened with their verbal consent at the time of their next infusion. Patients receiving subcutaneous treatments are being screened at their next appointment.