Akademik Veri Yönetim Sistemi
Hepatitis Monthly, cilt.26, sa.1, 2026 (SCI-Expanded, Scopus)
Background: Immunosuppressive therapies (IST) used in the management of immune-mediated inflammatory and chronic inflammatory diseases carry the risk of hepatitis B virus reactivation (HBVr), especially in patients with prior exposure to hepatitis B virus (HBV). Current guidelines emphasize screening and risk-based prophylaxis, yet real-world adherence and the comparative efficacy of regional versus international protocols remain to be fully elucidated. Objectives: This study aimed to evaluate the clinical outcomes of HBV screening and antiviral prophylaxis strategies in patients undergoing IST and to analyze the impact of guideline discrepancies on clinical management. Methods: A retrospective analysis of 624 patients referred for HBV evaluation before IST was conducted. Patients were stratified into risk groups according to American Gastroenterological Association (AGA) 2025 and Turkish National Guidelines. Clinical follow-up lasted at least 6 months, monitoring liver function tests and HBV serological markers. Results: The cohort (mean age 47.21 ± 13.21 years) comprised vaccinated (47.6%), unvaccinated (33.5%), and antiviral-receiving (18.9%) groups. A highly significant age difference was observed across these groups (P < 0.001), with the antiviral group being the oldest (58.1 ± 12.1 years). Antiviral prophylaxis was administered to 103 patients, including 51 who were classified as "low-risk" per AGA 2025 but "moderate-risk" per national guidelines. No HBV reactivation occurred in any patient, including those managed under conservative national protocols. Serological monitoring revealed anti-HBs loss in 33 (10.0%) patients and anti-HBc seroreversion in 3 patients. Conclusions: Adherence to structured screening and high-barrier antiviral prophylaxis (Tenofovir/Entecavir) is highly effective in preventing HBV reactivation. Discrepancies between guidelines suggest that conservative regional adaptations provide a robust safety margin in endemic areas. Long-term serological monitoring is essential due to the observed waning of immune markers under IST.