Management of Patients with Hepatitis B Virus Infection Who Receive Immunosuppressive Treatment or Chemotherapy

Abstract

Reactivation of hepatitis B virus (HBV) has been well documented as a complication in HBV surface antigen (HBsAg) carriers who receive cytotoxic or immunosuppressive therapy. With the recent introduction of newer agents with a high level of immunosuppressive effect, this unfavorable event often occurs in patients with HBsAg-negative and/or occult HBV infection. The first step in HBV reactivation management is the identification of the patients at risk of viral reactivation by testing for HBV serology prior to commencing immunosuppressive treatment or chemotherapy. Multiple publications have consistently indicated the benefit of prophylactic or preemptive antiviral therapy in this setting, and justified such approach before the start of cytotoxic therapy. Unresolved issues concerning such prophylactic approach remain in the situations of HBsAg-negative/anti-HBc-positive or negative status, which presumably consists of a large number of occult HBV infection cases. This topic review will summarize clinical issues related to HBV reactivation, focusing clinical manifestations, risk factors associated with HBV reactivation, and a growing body of evidence supporting preventive antiviral therapy in high-risk patients. (Korean J Med 2012;82:149-158)