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World J Gastroenterol. Mar 28, 2011; 17(12): 1531-1537
Published online Mar 28, 2011. doi: 10.3748/wjg.v17.i12.1531
Reactivation of hepatitis B virus infection after cytotoxic chemotherapy or immunosuppressive therapy
María Luisa Manzano-Alonso, Gregorio Castellano-Tortajada
María Luisa Manzano-Alonso, Gregorio Castellano-Tortajada, Department of Gastroenterology, Hospital 12 de Octubre, Av Andalucia, 28041 Madrid, Spain
Author contributions: Manzano-Alonso ML and Castellano-Tortajada G contributed towards the conception and design of the review and both wrote the manuscript.
Correspondence to: Maria Luisa Manzano-Alonso, MD, PhD, Department of Gastroenterology, Hospital 12 de Octubre, Av Andalucia, 28041 Madrid, Spain.
Telephone: +34-91-3908409 Fax: +34-91-3908280
Received: August 6, 2010
Revised: September 13, 2010
Accepted: September 20, 2010
Published online: March 28, 2011

Reactivation of hepatitis B is defined as the recurrence or an abrupt rise in hepatitis B virus (HBV) replication, often accompanied by an increase in serum transaminase levels, and both events occurring in a patient with a previous inactive hepatitis B infection. This reactivation can occur in situations in which the ratio of HBV replication and immune response is altered. It can happen during the treatment of hemato-oncological malignancies with chemotherapy and in immunosuppression of autoimmune diseases. Clinical manifestations of hepatitis B reactivation are variable and can range from asymptomatic to acute hepatitis, which are sometimes serious and result in acute liver failure with risk of death, and usually occur in the periods between cycles or at the end of chemotherapy. Immunosuppressive drugs such as corticosteroids or azathioprine can induce HBV reactivation in patients carrying hepatitis B virus surface antigen (HBsAg) or anti-HBc, but much less frequently than chemotherapy treatments. The tumor necrosis factor α inhibitors infliximab, etanercept and adalimumab may cause reactivation of hepatitis B, and the overall frequency with infliximab may be similar (50%-66%) to that caused by chemotherapy. Baseline HBV serology is recommended for all patients receiving chemotherapy and immunosuppressive drugs, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.

Keywords: Hepatitis B, Immune response, Immunosuppression, Reactivation