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Immunosuppression in Patients with Chronic Hepatitis B
Anil Seetharam1, Robert Perrillo2, Robert Gish3
1Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ USA ; University of Arizona College of Medicine, Phoenix, AZ USA.
Hepatitis B virus (HBV) can persist after infection, risking reactivation during immunosuppressive therapy. Prophylactic antiviral treatment is crucial for preventing severe liver disease in carriers and at-risk patients.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B virus (HBV) DNA can persist in hepatocytes post-infection, even in resolved cases.
- Reactivation of HBV during immunosuppressive therapy poses a risk, ranging from asymptomatic to life-threatening liver failure.
- Understanding the balance between viral persistence mechanisms and host immune control is key.
Approach:
- Review of recent studies on HBV reactivation in patients undergoing immunomodulatory therapies for various conditions.
- Emphasis on risk assessment through HBV screening and evaluation of immunosuppressive therapy potency.
- Discussion of monitoring strategies, prophylactic antiviral therapy, and treatment protocols for HBV reactivation.
Key Points:
- Patients with active, inactive, or resolved HBV infection are susceptible to reactivation under immunosuppression.
- HBV reactivation risk varies significantly, necessitating careful management.
- Prophylactic antiviral therapy is recommended for HBsAg carriers and selected anti-HBc positive patients.
Conclusions:
- HBV screening and assessment of immunosuppressive therapy are critical for risk stratification.
- Prophylactic antiviral treatment is essential for preventing HBV reactivation and improving patient outcomes.
- Monitoring and timely intervention are vital for managing HBV reactivation during immunomodulatory treatments.
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