Research advances in liver failure associated with hepatitis B virus reactivation

ABSTRACT

Hepatitis B virus (HBV) infection is a major public issue in the world. Although currently used antiviral drugs can effectively control virus replication, they cannot clear HBV and HBV reactivation is still observed after the withdrawal of anti-HBV drugs. Meanwhile, experimental studies and clinical research have shown that after HBV infection, although 95% of the adult patients can achieve clinical cure spontaneously, virus genome still exists in host hepatocytes, and when immunosuppressants or chemotherapeutic drugs are used for the treatment of underlying diseases such as solid tumor, hematological malignancies, rheumatic immune diseases, and HCV infection, HBV replication might be reactivated. HBV reactivation may lead to severe clinical outcomes, and some patients may experience liver failure or even death. Retrospective studies in China show that 9%-30% of the cases of acute-on-chronic hepatitis B liver failure are caused by HBV reactivation, and therefore, it is of great importance to identify the population at risk of HBV reactivation and develop reasonable preventive measures, which may help to reduce the development of acute-on-chronic hepatitis B liver failure. This article reviews the definition and basis of HBV reactivation, elaborates on the predisposing factors and mechanism of HBV reactivation in inducing liver failure, and summarizes the population requiring prevention and related preventive measures.