Infection screening before starting immunosuppression in interstitial lung disease: A Canadian Thoracic Society position statement

Immunosuppression remains a common treatment used in patients with interstitial lung disease (ILD) and can lead to increased risk of infection or reactivation of latent infections. In Canada, the most relevant infections include Mycobacterium tuberculosis, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and, in certain travelers or those from endemic regions, Strongyloides stercoralis. There are currently no specific recommendations to guide the evaluation of a patient with fibrotic ILD within the context of the Canadian practice landscape. This position statement from a multidisciplinary panel of ILD, infectious diseases, hepatology, rheumatology, immunology, lung transplant and tuberculosis experts and patient partners provides guidance related to the evaluation of active and latent infections in patients with ILD prior to starting immunosuppression. Key messages are provided to guide clinical practice based on a thorough review of the scientific literature.