Hepatitis B virus reactivation during immunosuppressive therapy: Appropriate risk stratification

Area of Science:

• Hepatology
• Immunology
• Virology

Background:

• Hepatitis B virus (HBV) reactivation is a concern during immunosuppressive therapy.
• Reactivation occurs in hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative, anti-HBc-positive individuals.
• Specific immunosuppressive agents like rituximab and anti-TNF increase reactivation risk.

Purpose of the Study:

• To review current understanding of HBV reactivation during immunosuppression.
• To compare antiviral prophylaxis efficacy.
• To highlight the need for risk stratification in managing HBV reactivation.

Main Methods:

• Literature review of HBV reactivation during immunosuppressive therapy.
• Analysis of data on prophylactic antiviral efficacy.
• Evaluation of reactivation risks in different patient groups and therapies.

Main Results:

• Prophylactic antiviral therapy effectively prevents HBV reactivation in HBsAg-positive patients.
• Entecavir shows greater efficacy than lamivudine for prophylaxis.
• HBsAg-negative, anti-HBc-positive individuals have varying reactivation risks depending on immunosuppression type, with rituximab showing a 41.5% 2-year cumulative risk.

Conclusions:

• Optimal management requires risk stratification for both HBsAg-positive and HBsAg-negative, anti-HBc-positive individuals.
• Further prospective data is needed for certain immunosuppressive regimens in HBsAg-negative patients.
• Tailored strategies are essential to prevent HBV reactivation effectively.