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. 2019 Nov;15(11):593–605.

Table 3.

Screening Tests for Serious and Opportunistic Infections

Disease Being Screened Screening Test(s) When to Screen
HBV

  • HBsAg

  • Anti-HBc

  • Anti-HBs

  • HBV DNA if HBsAg-positive or anti-HBc–positive and/or anti-HBs–positive

 Before anti-TNFα, vedolizumab, or immunosuppressant use
HCV

  • HCV antibodies

  • HCV RNA (if anti-HCV–positive)

 Before anti-TNFα or immunosuppressant use
Latent tuberculosis

  • Tuberculin skin test or QuantiFERON-TB Gold assay

  • Consider T-SPOT.TB assay if QuantiFERON-TB Gold is indeterminate.

  • Chest radiograph

 Before anti-TNFα or vedolizumab use
HIV

  • 4th-generation antigen/antibody HIV-1/-2 immunoassay; if positive, obtain plasma HIV RNA level

 Before anti-TNFα or immunosuppressant use
HPV

  • Papanicolaou test or HPV test (if available)

 Before anti-TNFα or immunosuppressant use
VZV

  • Obtain history of chicken pox or shingles.

  • IgM/IgG anti-VZV

 Before anti-TNFα or immunosuppressant use
Epstein-Barr virus

  • IgM/IgG anti–viral capsid antigen antibodies

  • IgM/IgG anti–Epstein-Barr nuclear antigen antibodies

  • IgM/IgG anti–early antigen antibodies

  • The Monospot test is not recommended for general use given its lack of specificity.

 Before thiopurine use
anti-HBc, hepatitis B core antibody; anti-HBs, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; HPV, human papilloma virus; Ig, immunoglobulin; TNF, tumor necrosis factor; VZV, varicella zoster virus.
Adapted from Mazzola G et al.111