Abstract

Objective

The growing use of biologic and targeted synthetic agents in immune-mediated inflammatory rheumatic diseases has made the management of underlying hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) infections an integral part of clinical practice. This study aimed to develop a national consensus report addressing screening, vaccination, prophylaxis, and treatment decisions specific to rheumatology practice.

Methods

A panel of rheumatology, gastroenterology, and infectious disease specialists conducted a focused literature search in PubMed and Scopus, and reviewed the European Association for the Study of the Liver, American Gastroenterological Association, Asian Pacific Association for the Study of the Liver, and American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines along with the Turkish Society of Rheumatology’s vaccination recommendations. Draft recommendations combining the available evidence with expert opinion were scored electronically on a 0-10 Likert scale; consensus was defined as at least 75% of participants scoring a recommendation ≥8.

Results

Consensus was reached on 22 recommendations, covering HBV screening (3 items), HBV vaccination (5 items), HBV prophylaxis and treatment (6 items), HCV screening and treatment (6 items), and HDV screening and treatment (2 items). The recommendations address which patients require which test panel, the strategy to follow in groups with impaired vaccine response, the timing of initiating and discontinuing prophylactic antiviral therapy, and the coordination of antiviral therapy with antirheumatic treatment.

Conclusion

This consensus report aligns broadly with international guidelines, offering concrete answers to questions specific to rheumatology practice. Because a substantial portion of the evidence base is not derived directly from rheumatic disease populations, the recommendations should be applied with attention to individual patient characteristics.