Recommendations

Sr.­no.

Recommendations

SoR

QoE

1

The AGA recommends antiviral prophylaxis over no prophylaxis for patients at high risk undergoing immunosuppressive drug therapy.
Comments: Treatment should be continued for at least 6 months after discontinuation of immunosuppressive therapy (at least 12 months for B cell-depleting agents).

Strong

Mod
Evidence for Recommendation 1

2

The AGA suggests antiviral prophylaxis over monitoring for patients at moderate risk undergoing immunosuppressive drug therapy.
Comments: Treatment should be continued for 6 months after discontinuation of immunosuppressive therapy. Patients who place a higher value on avoiding long-term use of antiviral therapy and the cost associated with its use and a lower value on avoiding the small risk of reactivation (particularly in those who are HBsAg negative) may reasonably select no prophylaxis over antiviral prophylaxis.

Weak

Mod
Evidence for Recommendation 2

3

The AGA suggests against routinely using antiviral prophylaxis in patients undergoing immunosuppressive drug therapy who are at low risk for HBVr.

Weak

Mod
Evidence for Recommendation 3

4

The AGA suggests against using anti-HBs status to guide antiviral prophylaxis for all risk groups.

Weak

V Low
Evidence for Recommendation 4

5

The AGA suggests use of antiviral drugs with a high barrier to resistance over lamivudine for prophylaxis in patients undergoing immunosuppressive drug therapy.
Comments: Given the geographic variability in cost of antiviral therapy, those patients who put a higher value on cost and a lower value on avoiding the potentially small risk of resistance development (particularly in those who have an undetectable viral load and who are expected to use antiviral prophylaxis for ≤6 months) may reasonably select the least expensive antiviral hepatitis B medication over more expensive antiviral drugs with a higher barrier to resistance.

Weak

Mod
Evidence for Recommendation 5

6

The AGA makes no recommendation for a strategy of HBV DNA monitoring followed by rescue treatment as an alternative to antiviral prophylaxis.

N/A

N/A
Evidence for Recommendation 6

7

The AGA recommends antiviral drugs with a high barrier to resistance over lamivudine for established HBVr in patients undergoing immunosuppressive drug therapy.

Strong

Mod
Evidence for Recommendation 7

8

The AGA recommends screening for HBV (HBsAg and anti-HBc, followed by a sensitive HBV DNA test if positive) in patients at moderate or high risk who will undergo immunosuppressive drug therapy.

Strong

Mod
Evidence for Recommendation 8

9

The AGA suggests against routinely screening for HBV in patients who will undergo immunosuppressive drug therapy and are at low risk.
Comments: Patients in populations with a baseline prevalence likely exceeding 2% for chronic HBV should be screened according to Centers for Disease Control and Prevention and US Preventive Services Task Force recommendations.

Weak

Mod
Evidence for Recommendation 9

SoR: Strength of Recommendation
QoE: Quality of Evidence
Strong: Strong Recommendation
Weak: Weak Recommendation
N/A: Not Applicable
Mod: Moderate-Quality Evidence
V Low: Very Low-Quality Evidence
AGA: American Gastroenterological Association
HBsAg: Hepatitis B surface antigen
HBVr: Hepatitis B virus reactivation
anti-HBc: Antibody to hepatitis B core antigen
anti-HBs: Antibody to hepatitis B surface antigen
HBV: Hepatitis B virus
DNA: Deoxyribonucleic acid
US: United States