Clin Mol Hepatol.  2016 Jun;22(2):219-237. 10.3350/cmh.2016.0024.

Prevention of Hepatitis B reactivation in the setting of immunosuppression

• Pattullo V

• KMID: 2373118
• DOI: http://doi.org/10.3350/cmh.2016.0024

Abstract

Advances in the treatment of malignant and inflammatory diseases have developed over time, with increasing use of chemotherapeutic and immunosuppressive agents of a range of drug classes with varying mechanism and potency in their effects on the immune system. These advances have been met with the challenge of increased risk of hepatitis B virus (HBV) reactivation in susceptible individuals. The magnitude of risk of HBV reactivation is associated with the individual's HBV serological status and the potency and duration of immunosuppression. Individuals with chronic hepatitis B (CHB) and previously infected but serologically cleared HBV infection are both susceptible to HBV reactivation. HBV reactivation in the setting of immunosuppression is a potentially life threatening condition leading to liver failure and death in extreme cases. It is important to recognize that HBV reactivation in the setting of immunosuppression is potentially preventable. Therefore, identification of patients at risk of HBV reactivation and institution of prophylactic antiviral therapy prior to initiation of immunosuppression is essential.

Keyword

Hepatitis B reactivation; Prophylaxis; Chemotherapy; Immunosuppression; Guidelines

MeSH Terms

Antiviral Agents/therapeutic use
Autoimmune Diseases/complications/pathology
Hematopoietic Stem Cell Transplantation
Hepatitis B/complications/drug therapy
Hepatitis B Core Antigens/blood
Hepatitis B Surface Antigens/blood
Hepatitis B virus/*physiology
Humans
Immunosuppressive Agents/therapeutic use
Organ Transplantation
Virus Activation/*physiology
Antiviral Agents
Hepatitis B Core Antigens
Hepatitis B Surface Antigens
Immunosuppressive Agents