Hepatitis B Reactivation: The Controversies Continue

Abstract

Hepatitis B virus (HBV) reactivation is a serious but largely avoidable complication of immunosuppressive therapy. The consequences of reactivation range from subclinical increases in HBV DNA to fulminant liver failure, which can be prevented with the appropriate use of prophylactic antiviral therapy. However, which patients need to be screened and whether all patients who test positive for any serological test require antiviral therapy are issues that still remain unclear. Additional issues such as the choice of antiviral and the duration of treatment also need clarification. Some of the confusion comes from the use of varying definitions in the literature to define outcomes. In this review, areas of controversy from definitions of reactivation to management of patients who are hepatitis B surface antigen and lone anti-core antibody positive in different clinical settings are discussed. The recently recognized issue of reactivation in the setting of hepatitis C antiviral therapy is also addressed as well as some recommendations for areas of future research to help clarify best practices.

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

“…(a) Host related factors: HBV reactivation is likely to be more severe in young males with pre-existing raised ALT; (b) Viral factors: More severe with high HBV DNA, HBsAg and HBeAg levels 44 and in those with pre-core or core promotor mutants 45 ; and (c) Factors related to immunosuppressive agents: its potency, dose and duration (particularly severe after rituximab, anthracycline drugs and after stem cell transplantation). 46 By combination of various factors, a system of classification has been proposed for HBV reactivation 47 (Table 3). This classification can be useful in categorizing patients for research in this area.…”

RFX1 participates in doxorubicin‐induced hepatitis B virus reactivation

“…Hepatitis B virus (HBV) reactivation has been confirmed to frequently occur in hepatitis B surface antigen (HBsAg)positive HBV-infected individuals who receive cancer chemotherapy [2][3][4][5][6][7][8][9]. HBV reactivation may also occur in previously resolved or inactive HBV carriers, but the risk seems to be lower [4,[10][11][12].…”