ABSTRACT
Current recommendations concerning hepatitis C virus (HBV) reactivation are limited, with nearly all guidelines focused on its occurrence in patients with hematological malignancies or some solid tumors, who are treated with immunosuppressive therapies. Few of the guidelines address reactivation in patients receiving immunosuppression with organ transplants or treatment with any of the many immunosuppressive agents in use today for the treatment of multiple different diseases, or in patients receiving the direct-acting antivirals used in the treatment of hepatitis C virus (HCV). This article covers the immunology of HBV reactivation, mechanisms of viral clearance, and recommendations for screening and prophylaxis.
Subject(s)
Adaptive Immunity/immunology , Hepatitis B virus/physiology , Hepatitis B/virology , Immunity, Innate/immunology , Immunosuppressive Agents/therapeutic use , Virus Activation/immunology , Adaptive Immunity/drug effects , Female , Hepatitis B/physiopathology , Humans , Immunity, Innate/drug effects , Male , Mass Screening/methods , Primary Prevention , Prognosis , Risk AssessmentABSTRACT
Organ transplantation is a lifesaving procedure for many patients. To prevent rejection or graft-versus-host disease, recipients require long-term immunosuppression. In patients who have ever been exposed to hepatitis B, it is possible for reactivation to occur; this includes patients who are anti-hepatitis B core antibody-positive only or both anti-hepatitis B core antibody-positive and hepatitis B surface antibody-positive. The susceptibility to this varies with the nature of the transplant. Hepatitis B can be transmitted from donor to recipient. It is important to assess the hepatitis B status and formulate a strategy to prevent transmission and prevent reactivation.
Subject(s)
Graft vs Host Disease/immunology , Hepatitis B virus/drug effects , Hepatitis B/prevention & control , Liver Transplantation/adverse effects , Virus Activation/immunology , Antiviral Agents/therapeutic use , Disease Transmission, Infectious , Female , Graft Survival , Graft vs Host Disease/physiopathology , Hepatitis B/drug therapy , Hepatitis B virus/immunology , Humans , Liver Transplantation/methods , Male , Mass Screening , Prognosis , Survival Analysis , Transplant Recipients , Treatment Outcome , Virus Activation/drug effectsABSTRACT
Because of the relatively high prevalence of both hepatitis B infection and various forms of autoimmune inflammatory diseases treated with aggressive immunotherapy, reactivation of hepatitis B occurs in a substantial number of patients. The risk of reactivation depends on the degree and duration of immunosuppression. A large number of drug treatments have resulted in reactivation of hepatitis B virus infection and, based on the mechanisms and extent of immunosuppression, recommendations for some of the newer classes of immunosuppressive drugs are provided.
