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World J Gastroenterol. Oct 28, 2014; 20(40): 14581-14588
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14581
Chemotherapy-related reactivation of hepatitis B infection: Updates in 2013
Hwi Young Kim, Won Kim
Hwi Young Kim, Won Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 156-707, South Korea
Author contributions: Kim HY collected data, reviewed literatures, and wrote the manuscript; Kim W designed this review, appraised critically and revised the manuscript.
Correspondence to: Won Kim, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, South Korea. drwon1@snu.ac.kr
Telephone: +82-2-8702233 Fax: +82-2-8312826
Received: October 29, 2013
Revised: February 18, 2014
Accepted: May 19, 2014
Published online: October 28, 2014
Abstract

Hepatitis B reactivation is a potentially serious complication of anticancer chemotherapy, which occurs during and after therapy. This condition affects primarily hepatitis B surface antigen (HBsAg)-positive patients, but sometimes HBsAg-negative patients can be at risk, based only on evidence of past infection or occult infection with a low titer of detectable hepatitis B virus (HBV) DNA. The clinical outcomes vary with the different degrees of virologic and biochemical rebound, ranging from asymptomatic elevations in liver enzymes to hepatic failure and even death. Despite the remarkable advancement in the treatment of chronic hepatitis B over the past decade, proper strategies for the prevention and management of HBV reactivation remain elusive. Moreover, with the increasing use of rituximab in patients with lymphoma, HBV reactivation in occult or past infections has become increasingly problematic, especially in HBV-endemic regions. This review addresses the current knowledge on the clinical aspects and management of chemotherapy-related HBV reactivation, updates from recent reports, several unresolved issues and future perspectives.

Keywords: Hepatitis B virus, Chemotherapy, Reactivation

Core tip: Hepatitis B reactivation is a serious complication of anticancer chemotherapy, affecting both hepatitis B surface antigen-positive and anti-hepatitis B core antibody-positive patients. Although treatment of hepatitis B has been dramatically improved in the past decade, management of hepatitis B virus (HBV) reactivation remains unsatisfactory. This review covers updates from recent reports, unresolved issues and future perspectives on HBV reactivation.