ABSTRACT
Introduction of biologic agents to treat patients with rheumatic diseases and cancer has improved clinical outcomes. However, this advance increases the risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen carrier and even in resolved HBV infection, which can lead to liver failure and even death. In particular, the risk of HBV reactivation is heightened by the use of B-cell depleting agents such as rituximab, high dose corticosteroid, and anti-tumor necrosis factor-α. Therefore, identification of individuals at risk, and understanding the mechanism of HBV reactivation are essential to preventing HBV reactivation before initiating immunosuppressive therapy. Here, we review the mechanism, incidence, and prevention of HBV reactivation in the setting of immunosuppression.
Subject(s)
Humans , B-Lymphocytes , Biological Factors , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Immunosuppression Therapy , Immunosuppressive Agents , Incidence , Liver Failure , Necrosis , Rheumatic Diseases , RituximabABSTRACT
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.
Subject(s)
Humans , Antiviral Agents/therapeutic use , Autoimmune Diseases/complications , Hematopoietic Stem Cell Transplantation , Hepatitis B/complications , Hepatitis B Core Antigens/blood , Hepatitis B Surface Antigens/blood , Hepatitis B virus/physiology , Immunosuppressive Agents/therapeutic use , Organ Transplantation , Virus Activation/physiologyABSTRACT
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.