Hepatitis-B virus reactivation during Immunosuppressive therapy: Clinical observations from a tertiary care center

This study evaluated the incidence of hepatitis-B virus reactivation (HBVr) in patients receiving immunosuppressive therapy and examined the association between anti-HBs titers and reactivation risk in routine clinical practice.

This retrospective study was conducted at Duzce University Faculty of Medicine Hospital between 2017 and 2020. Adult patients (≥18 years) receiving immunosuppressive therapy and monitored for HBVr were included. A total of 166 patients who were either HBsAg (+) or HBsAg (-) with anti-HBc positivity were analyzed. Demographic and clinical characteristics, type of immunosuppressive therapy, antiviral prophylaxis use, HBV serological markers, HBV DNA levels, and HBVr episodes were obtained from medical records. Patients were categorized into three groups based on their serological status and prophylaxis use: HBsAg (-) / anti-HBc (+) patients not receiving antiviral prophylaxis constituted Group-1 (n=104), HBsAg (-) / anti-HBc (+) patients receiving antiviral prophylaxis constituted Group-2 (n=46), and HBsAg (+) patients receiving antiviral prophylaxis constituted Group-3 (n=16). Statistical analyses were performed using SPSS version 22.0, with p < 0.05 considered statistically significant.

The mean age of the cohort was 54 ± 12.7 years, and 42.1% were male. Most patients were HBsAg (-) / anti-HBc (+) (90.4%), while 9.6% were HBsAg (+). Antiviral prophylaxis was administered to 37.3% of patients. HBVr occurred in 17.3% of HBsAg (-) / anti-HBc (+) patients without prophylaxis and was significantly more frequent in those with anti-HBs titers <100 mIU/mL than in those with titers ≥100 mIU/mL (p = 0.049). Among HBsAg (-) / anti-HBc (+) patients receiving prophylaxis, HBVr was observed in 8.7%. Only one HBVr episode occurred among HBsAg (+) patients receiving prophylaxis.

HBVr risk during immunosuppressive therapy is shaped by HBsAg status, antiviral prophylaxis, and anti-HBs titers. Prophylaxis markedly reduces risk, while anti-HBs titers ≥100 mIU/mL provide additional protection and may guide individualized prophylaxis strategies.