Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3299
Peer-review started: March 18, 2019
First decision: April 16, 2019
Revised: May 10, 2019
Accepted: May 18, 2019
Article in press: May 18, 2019
Published online: July 14, 2019
Reactivation of hepatitis B virus (HBV) replication is characterized by increased HBV-DNA serum values of about 1 log or by HBV DNA turning positive if previously undetectable in serum, possibly associated with liver damage and seldom life-threatening. Due to HBV reactivation, hepatitis B surface antigen (HBsAg)-negative/anti-HBc-positive subjects may revert to HBsAg-positive. In patients with hemo-lymphoproliferative disease, the frequency of HBV reactivation depends on the type of lymphoproliferative disorder, the individual's HBV serological status and the potency and duration of immunosuppression. In particular, it occurs in 10%-50% of the HBsAg-positive and in 2%-25% of the HBsAg- negative/anti-HBc-positive, the highest incidences being registered in patients receiving rituximab-based therapy. HBV reactivation can be prevented by accurate screening of patients at risk and by a pharmacological prophylaxis with anti-HBV nucleo(t)sides starting 2-3 wk before the beginning of immunosuppressive treatment and covering the entire period of administration of immunosuppressive drugs and a long subsequent period, the duration of which depends substantially on the degree of immunodepression achieved. Patients with significant HBV replication before immunosuppressive therapy should receive anti-HBV nucleo(t)sides as a long-term (may be life-long) treatment. This review article is mainly directed to doctors engaged every day in the treatment of patients with onco-lymphoproliferative diseases, so that they can broaden their knowledge on HBV infection and on its reactivation induced by the drugs with high immunosuppressive potential that they use in the care of their patients.
Core tip: Hepatitis B virus (HBV) reactivation frequently exerts a negative impact on the outcome of patients with hemo-lymphoproliferative disorders both by liver injury, at times severe, and a premature delay or termination of immunosuppressive treatments. Patients at risk should be identified by screening of HBV serum markers before immunosuppressive therapy is started. The use of HBV nucle(t)side analogues, as treatment or prophylaxis, is effective in limiting the frequency and intensity of the damage caused. Antivirals should be administered 2-3 wk before starting immunosuppressive treatment, for the entire immunosuppressive period and during post-treatment follow-up, the length of which depends on the intensity of immunosuppression reached.