Latent tuberculosis and hepatitis B can reactivate on biologic and targeted synthetic DMARDs, and both are common in India. Screening before starting is standard in national and international guidance.
For tuberculosis, use an interferon-gamma release assay or tuberculin skin test with a chest radiograph and a clinical history. For hepatitis B, test HBsAg and anti-HBc; a patient positive for anti-HBc alone may still reactivate, particularly on rituximab, and needs monitoring or prophylaxis by local protocol.
- Test for latent TB with IGRA or tuberculin skin test plus chest radiograph before starting.
- Complete or start latent TB treatment, per local guidance, before the biologic where infection is found.
- Test HBsAg, anti-HBc and anti-HBs before treatment.
- Arrange antiviral prophylaxis or HBV DNA monitoring for HBsAg-positive or anti-HBc-positive patients as advised.
- Update vaccinations, avoiding live vaccines once immunosuppression begins.
Why it matters
Reactivation is largely preventable, and in India the background prevalence makes screening essential.
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