Published online Mar 18, 2016. doi: 10.4254/wjh.v8.i8.385
Peer-review started: May 25, 2015
First decision: August 16, 2015
Revised: January 15, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: March 18, 2016
The proportion of hepatitis B virus (HBV) previously exposed patients who receive immunosuppressive treatment is usually very small. However, if these individuals are exposed to potent immunosuppressive compounds, the risk of HBV reactivation (HBVr) increases with the presence of hepatitis B surface antigen (HBsAg) in the serum. Chronic HBsAg carriers have a higher risk than those who have a total IgG anticore as the only marker of resolved/occult HBV disease. The loss of immune control in these patients may results in the reactivation of HBV replication within hepatocytes. Upon reconstitution of the immune system, infected hepatocytes are once again targeted and damaged by immune surveillance in an effort to clear the virus. There are different virological scenarios, and a wide spectrum of associated drugs with specific and stratified risk for the development of HBVr. Some of this agents can trigger a severe degree of hepatocellular damage, including hepatitis, acute liver failure, and even death despite employment of effective antiviral therapies. Currently, HBVr incidence seems to be increasing around the world; a fact mainly related to the incessant appearance of more powerful immunosuppressive drugs launched to the market. Moreover, there is no consensus on the length of prophylactic treatment before the patients are treated with immunosuppressive therapy, and for how long this therapy should be extended once treatment is completed. Therefore, this review article will focus on when to treat, when to monitor, what patients should receive HBV therapy, and what drugs should be selected for each scenario. Lastly, we will update the definition, risk factors, screening, and treatment recommendations based on both current and different HBV management guidelines.
Core tip: Chronic hepatitis B surface antigen carriers have a high risk to develop hepatitis B virus (HBV) reactivation (HBVr) when exposed to immunosupresive therapy. The loss of immune control in these patients may results in an increase in HBV replication. There is a wide spectrum of associated drugs with specific and stratified risk for the development of HBVr. Currently, HBVr incidence seems to increase worldwide, mainly due to the appearance of more powerful immunosuppressive drugs. This review article focus on when to treat, when to monitor, what patients should receive HBV therapy, and what drugs should be selected in each scenario. We updated here current HBV management guidelines.