All rheumatology patients should be screened for hepatitis B before starting long-term immunosuppressive treatment, the conference has heard.

Speaking at a plenary session on hepatology for rheumatologists Professor Ed Gane, Chief hepatologist at Auckland City Hospitals Liver Transplant Unit told delegates there were currently 500,000 people in Australia living with chronic viral hepatitis and many were unaware they had it.

“You need to check all your patients at some stage during your clinic assessment,” he advised, noting that a surface antigen test was simple and cheap.

The risk was highest for people from Asian Pacific and Maori populations, who were thought to have between a 6 to 10 percent chance of having the disease.

“Certainly screen all Asia Pacific and Maori patients and you should also screen all New Zealand and European patients who were brought up in this country over the age of 15 because they also have a risk, although it is lower,” he said.

He told delegates that patients who were Hepatitis B surface antigen (HbsAg) positive were at risk of reactivation after high dose steroids or disease modifying drugs and would require antiviral prophylaxis for at least six months.

HbsAg negative / anti-Hbcore positive patients were at a particular high-risk of reactivation if they were taking rituximab, mainly because of the drug’s mechanism of action on B cells, Professor Gane said.

“These patients should get prolonged prophylaxis for at least 12 months, and the guidelines are saying for up to 18 months,” he told delegates.