From the Guidelines
HIV, QuantiFERON-TB Gold, and Hepatitis B profile testing are generally recommended before starting IVIG (Intravenous Immunoglobulin) therapy. These tests are important for baseline assessment and risk management. HIV testing helps identify patients who may have compromised immune systems, which could affect IVIG response and management. QuantiFERON-TB Gold testing screens for latent tuberculosis infection, which is important because IVIG can potentially affect immune responses to TB. Hepatitis B testing is particularly crucial as IVIG products may contain anti-HBs antibodies that could interfere with viral replication in patients with chronic hepatitis B, potentially causing immune-mediated hepatitis flares.
Key Points to Consider
- According to the 2022 EULAR recommendations 1, screening for latent tuberculosis, HIV, and hepatitis B is crucial before starting certain immunosuppressive therapies.
- The British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 2, 3 also emphasize the importance of screening for tuberculosis and other infections before initiating immunosuppressive therapy.
- The KASL clinical practice guidelines for the management of chronic hepatitis B 4 recommend screening for HBsAg and anti-HBc before immunosuppression or chemotherapy.
- Primary care guidelines for the management of persons infected with HIV 5, 6 suggest screening for various infections, including hepatitis B and tuberculosis, as part of the initial evaluation.
Testing Recommendations
- HIV testing: to identify patients with compromised immune systems, which could affect IVIG response and management.
- QuantiFERON-TB Gold testing: to screen for latent tuberculosis infection, which is important because IVIG can potentially affect immune responses to TB.
- Hepatitis B testing: to identify patients with chronic hepatitis B, as IVIG products may contain anti-HBs antibodies that could interfere with viral replication, potentially causing immune-mediated hepatitis flares. While specific institutional protocols may vary, these screenings represent standard practice to ensure safe administration of IVIG and appropriate patient monitoring during treatment.
From the Research
Indications for HIV QUANTIFERON-TB GOLD HEPATITIS B PROFILE before starting IVIG
- The studies provided do not directly address the indication for HIV QUANTIFERON-TB GOLD HEPATITIS B PROFILE before starting IVIG 7, 8, 9, 10, 11.
- However, it can be inferred that screening for blood-borne viral diseases such as HIV, Hepatitis B, and Hepatitis C is crucial before starting IVIG therapy, as each unit of IVIG is obtained from different blood donors 7.
- The study by 7 investigated the prevalence of various viral infections, including HIV, Hepatitis B, and Hepatitis C, among patients referred for IVIG therapy and found that two female cases showed positive results for HBV Ab and HBS Ag after receiving IVIG.
- Another study by 9 treated patients with HIV-related immune thrombocytopenia with IVIG and found that it was effective in increasing platelet count, but did not discuss the screening for HIV QUANTIFERON-TB GOLD HEPATITIS B PROFILE before starting IVIG.
- The other studies provided discuss the use of IVIG in various conditions, including primary immunodeficiency disease, autoimmune hemolytic anemia, and Kawasaki disease, but do not specifically address the indication for HIV QUANTIFERON-TB GOLD HEPATITIS B PROFILE before starting IVIG 8, 10, 11.
Screening for Blood-Borne Viral Diseases
- Screening for blood-borne viral diseases is essential before starting IVIG therapy to prevent the transmission of these diseases 7.
- The studies provided do not specifically recommend HIV QUANTIFERON-TB GOLD HEPATITIS B PROFILE as a screening test before starting IVIG, but emphasize the importance of screening for blood-borne viral diseases 7, 8, 9, 10, 11.