Document No.

HAHO-COC-GL-MED-004-v01
Hospital Authority Head Office Issue Date 30/06/2017
Frequently Asked Questions on the Guideline of Pre-emptive Review Date 30/06/2020
Use of Nucleos(t)ide Analogues in Patients with Hepatitis B Page 1 of 3
Infection Receiving Immunosuppressive Therapy

Frequently Asked Questions on the Guideline of Pre-emptive

Use of Nucleos(t)ide Analogues in Patients with Hepatitis B
Infection Receiving Immunosuppressive Therapy

Version Effective Date Risk Rating

1.0 01/07/2017

Document Number HAHO-COC-GL-MED-004-v01

Author Working Group on Pre-emptive Use of Nucleos(t)ide
Analogues in Patients with Hepatitis B Infection
Receiving Immunosuppressive Therapy
Custodian Secretary, COC in Internal Medicine
Approved/ Endorsed By COC in Internal Medicine
Approval Date 28 Jun 2017
Distribution List Members of COC in Internal Medicine

This printed copy may not be the most updated version. Please refer to the electronic version for confirmation if in doubt.
 Document No. HAHO-COC-GL-MED-004-v01
Hospital Authority Head Office Issue Date 30/06/2017
Frequently Asked Questions on the Guideline of Pre-emptive Review Date 30/06/2020
Use of Nucleos(t)ide Analogues in Patients with Hepatitis B Page 2 of 3
Infection Receiving Immunosuppressive Therapy

Frequently Asked Questions on the Guideline of Pre-emptive use of nucleos(t)ide analogues

in patients with hepatitis B infection receiving immunosuppressive therapy

Q1 How to define high / moderate / low risk groups for steroid users?

A1
Dosage1
Topical /
< 10mg 10-20mg > 20mg
inhalational
Duration
1 week Low Low Low Low
> 1 week but
Insufficient data to support recommendation2 Low
< 4 weeks
4 weeks Moderate High High Low

Cyclic use3 Insufficient data to support recommendation2 Low

1
Prednisone daily or equivalent (prednisolone 10mg = dexamethasone 1.5mg =
hydrocortisone 40mg).
2
Monitoring liver function test.
3
For COPD patients with frequent exacerbation and requiring repeated short courses
of steroid, it is a good practice to know their HBV status and if positive, monitor their
liver function.

Q2 Should prophylaxis be routinely given to moderate risk group?

A2 Individualized informed decision on prophylaxis for moderate risk group is allowed.

Patients who wish to avoid the long-term use of antiviral therapy and accept the small
risk of reactivation may choose no prophylaxis over antiviral prophylaxis.

Q3 What is the HADF status of the nucleos(t)ide analogue?

A3 The nucleos(t)ide analogue used for high-risk and moderate-risk group is classified
under the category of special drug in the HADF.

Q4 Is it necessary to check HBV status for the low risk group?

A4 Routine checking for HBV status is not required for low risk groups. For COPD patients
with frequent exacerbation and requiring repeated short courses of steroid, it is a good
practice to know their HBV status and if positive, monitor their liver function.

Q5 Is it necessary to monitor liver function test (LFT) in known HBV carriers in the low
risk group?

A5 The low risk HBsAg+ group while on steroid should be followed up and managed as
usual by the parent team.

This printed copy may not be the most updated version. Please refer to the electronic version for confirmation if in doubt
 Document No. HAHO-COC-GL-MED-004-v01
Hospital Authority Head Office Issue Date 30/06/2017
Frequently Asked Questions on the Guideline of Pre-emptive Review Date 30/06/2020
Use of Nucleos(t)ide Analogues in Patients with Hepatitis B Page 3 of 3
Infection Receiving Immunosuppressive Therapy

Q6 In case of emergency steroid treatment (moderate / high risk) and the HBV status is
not known, what should I prescribe?

A6 In case of emergency steroid treatment (moderate / high risk), HBsAg can be checked
at the same time of starting steroid and steroid should not be withheld till HBsAg
results become available. Anti-viral prophylaxis should be started as soon as possible
when indicated.

Q7 How do I prescribe anti-viral while I do not have prescription right under HADF?

A7 The Cluster or the Hospital Drug and Therapeutics Committees may include additional
clinical specialties internally for drug prescription for operational needs. Specialists
other than those recommended clinical specialties may also prescribe special drugs
according to the clinical needs of individual patients upon consultation with the latter.
There is no need for urgent medical consultation for this purpose. Liaison with local
medical department for prescription of prophylaxis and subsequent care of patients is
recommended.

Q8 Is this Guideline applicable to my patients? Why is the common regimen used in my

patients not covered in this Guideline?

A8 This Guideline is intended to serve as a reference for clinicians in the management of

adult patients who are planning to receive certain types of chemotherapy,
corticosteroids, immunosuppressive or immunomodulatory agents. It will not cover
fully the recommendations of antiviral prophylaxis for special patient groups such as
cancer chemotherapy, organ transplants, paediatric or HIV infected patients. It is
recommended for individual COC/CC to develop her own guideline to fit her patient
population and seek additional information and expert opinion if it is not covered in
this Guideline. As clinical evidence is still evolving in this field and the indications and
availability of antiviral drugs in HADF may change with time, clinicians should exercise
their clinical judgment in the management of each individual patient. Last but not
least, explanation and informed decision by patients are also important.

This printed copy may not be the most updated version. Please refer to the electronic version for confirmation if in doubt