Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat?
Hepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article wa...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/2/393 |
| _version_ | 1797339677490937856 |
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| author | Sama Anvari Keith Tsoi |
| author_facet | Sama Anvari Keith Tsoi |
| author_sort | Sama Anvari |
| collection | DOAJ |
| description | Hepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article was to review the literature on risks of HBV reactivation associated with immunosuppressive agents and propose a management algorithm. We searched Google Scholar, PubMed, and MEDLINE for studies related to hepatitis B reactivation and various immunosuppressive agents. The risk of HBV reactivation was found to differ by agent and depending on whether a patient had chronic HBV (HBsAg+) or past HBV (HBsAg−, anti-HBc+). The highest risk of reactivation (>10%) was associated with anti-CD20 agents and hematopoietic stem cell transplants. Multiple societies recommend HBV-specific anti-viral prophylaxis for patients with positive HBsAg prior to the initiation of immunosuppressive therapy, while the guidance for HBsAg− patients is more variable. Clinicians should check HBV status prior to beginning an immune-suppressive therapy. Patients with positive HBsAg should be initiated on antiviral prophylaxis in the majority of cases, whereas HBsAg− individuals should be evaluated on a case-by-case basis. Further research is required to determine the optimum duration of therapy. |
| first_indexed | 2024-03-08T09:51:50Z |
| format | Article |
| id | doaj.art-57484c1796c64c99bd4cf74d20f5fe05 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T09:51:50Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-57484c1796c64c99bd4cf74d20f5fe052024-01-29T14:01:23ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113239310.3390/jcm13020393Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat?Sama Anvari0Keith Tsoi1Division of Gastroenterology, Department of Internal Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Gastroenterology, Department of Internal Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaHepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article was to review the literature on risks of HBV reactivation associated with immunosuppressive agents and propose a management algorithm. We searched Google Scholar, PubMed, and MEDLINE for studies related to hepatitis B reactivation and various immunosuppressive agents. The risk of HBV reactivation was found to differ by agent and depending on whether a patient had chronic HBV (HBsAg+) or past HBV (HBsAg−, anti-HBc+). The highest risk of reactivation (>10%) was associated with anti-CD20 agents and hematopoietic stem cell transplants. Multiple societies recommend HBV-specific anti-viral prophylaxis for patients with positive HBsAg prior to the initiation of immunosuppressive therapy, while the guidance for HBsAg− patients is more variable. Clinicians should check HBV status prior to beginning an immune-suppressive therapy. Patients with positive HBsAg should be initiated on antiviral prophylaxis in the majority of cases, whereas HBsAg− individuals should be evaluated on a case-by-case basis. Further research is required to determine the optimum duration of therapy.https://www.mdpi.com/2077-0383/13/2/393hepatitis B virusreactivationimmunosuppressionhepatitis |
| spellingShingle | Sama Anvari Keith Tsoi Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? Journal of Clinical Medicine hepatitis B virus reactivation immunosuppression hepatitis |
| title | Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? |
| title_full | Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? |
| title_fullStr | Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? |
| title_full_unstemmed | Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? |
| title_short | Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat? |
| title_sort | hepatitis b virus reactivation with immunosuppression a hidden threat |
| topic | hepatitis B virus reactivation immunosuppression hepatitis |
| url | https://www.mdpi.com/2077-0383/13/2/393 |
| work_keys_str_mv | AT samaanvari hepatitisbvirusreactivationwithimmunosuppressionahiddenthreat AT keithtsoi hepatitisbvirusreactivationwithimmunosuppressionahiddenthreat |