TY - JOUR
T1 - Management of patients with hepatitis B who require immunosuppressive therapy
AU - Hwang, Jessica P.
AU - Lok, Anna S.F.
N1 - Funding Information:
The authors acknowledge Laurissa Gann for assistance with the literature search. The work of A. S.-F. Lok is partially funded by a National Institute of Diabetes and Digestive and Kidney Diseases grant U01DK082863. J. P. Hwang is a recipient of a National Cancer Institute (NCI) KO7 Career Development Award (CA132955) and NCI R21 (CA167202). The content of this Review is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
PY - 2014/4
Y1 - 2014/4
N2 - Patients with chronic HBV infection are at risk of reactivation of HBV should they require immunosuppressive therapies for a variety of clinical settings, including chemotherapy for patients with cancer, immunosuppression for solid organ and stem cell transplant recipients, and use of anti-CD20 antibodies, TNF inhibitors, or corticosteroids in patients with oncological, gastrointestinal, rheumatological or dermatological conditions. The key to preventing HBV reactivation is the identification of patients with HBV infection prior to immunosuppressive therapy, initiation of prophylactic antiviral therapy in patients at moderate or high risk of HBV reactivation, and close monitoring of other patients so that antiviral therapy can be initiated at the first sign of HBV reactivation. Unfortunately, many patients infected with HBV are unaware of their infection or risk factors, and physicians often do not have sufficient time to systematically assess patients for risk factors for HBV prior to starting immunosuppressive therapy. In this article, we review the incidence, risk factors and outcomes of HBV reactivation, and the efficacy of antiviral therapy in preventing its occurrence. We also propose an algorithm for managing patients with HBV infection who require immunosuppressive therapy.
AB - Patients with chronic HBV infection are at risk of reactivation of HBV should they require immunosuppressive therapies for a variety of clinical settings, including chemotherapy for patients with cancer, immunosuppression for solid organ and stem cell transplant recipients, and use of anti-CD20 antibodies, TNF inhibitors, or corticosteroids in patients with oncological, gastrointestinal, rheumatological or dermatological conditions. The key to preventing HBV reactivation is the identification of patients with HBV infection prior to immunosuppressive therapy, initiation of prophylactic antiviral therapy in patients at moderate or high risk of HBV reactivation, and close monitoring of other patients so that antiviral therapy can be initiated at the first sign of HBV reactivation. Unfortunately, many patients infected with HBV are unaware of their infection or risk factors, and physicians often do not have sufficient time to systematically assess patients for risk factors for HBV prior to starting immunosuppressive therapy. In this article, we review the incidence, risk factors and outcomes of HBV reactivation, and the efficacy of antiviral therapy in preventing its occurrence. We also propose an algorithm for managing patients with HBV infection who require immunosuppressive therapy.
UR - http://www.scopus.com/inward/record.url?scp=84897988099&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84897988099&partnerID=8YFLogxK
U2 - 10.1038/nrgastro.2013.216
DO - 10.1038/nrgastro.2013.216
M3 - Review article
C2 - 24247262
AN - SCOPUS:84897988099
SN - 1759-5045
VL - 11
SP - 209
EP - 219
JO - Nature Reviews Gastroenterology and Hepatology
JF - Nature Reviews Gastroenterology and Hepatology
IS - 4
ER -