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Yoon: Prophylactic Antiviral Treatment in Immunosuppressed Chronic Hepatitis B Patients
Special Review
Diagnosis and Treatment of Chronic Hepatitis B: How Far Have We Come?

The Korean Journal of Gastroenterology 2019; 74(5): 258-266.

Published online: 27 November 2019

DOI: https://doi.org/10.4166/kjg.2019.74.5.258

Prophylactic Antiviral Treatment in Immunosuppressed Chronic Hepatitis B Patients

Eileen L. Yoon

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Correspondence to: Eileen L. Yoon, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea. Tel: +82-2-950-8824, Fax: +82-2-950-8886, mseileen80@gmail.com

Received 18 October 2019       Revised 18 October 2019       Accepted 9 November 2019

Copyright © 2019. Korean Society of Gastroenterology

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Improved management of chronic hepatitis B patients with oral nucleos(t)ide analogues has increased the number of these patients who are getting older and have other accompanying comorbidities. These comorbidities frequently require various immunosuppression treatments and/or cytotoxic chemotherapy. Not only the patients who are positive for HBsAg, but also the patients who are positive for isolated anti-HBc are at risk for hepatitis B reactivation during immunosuppression. Prophylactic antiviral treatment with oral nucleos(t)ide analogues with high genetic barriers can decrease the risks of HBV reactivation, HBV reactivation-associated hepatitis, and mortality in these patients. It is crucial to screen HBV markers in all of the patients who have to undergo immunosuppression, be administered prophylactic antiviral treatment in the high risk groups, and be monitored for HBV reactivation during and after immunosuppression and/or cytotoxic chemotherapy. This study summarizes the recommendations from the recently updated guidelines from Korea, United States, and Europe.

Keywords: Hepatitis B, chronic, Immunosuppression, Reactivation, Prophylactic

Figures and Tables

Table 1

Summarise for Management of Chronic Hepatitis B in immunocompromised Patients from the Korean Associations for the Study of the Liver Guideline and Other International Guidelines

kjg-74-258-i001

KASL, Korean Associations for the Study of Liver; AASLD, American Association for the Study of Liver Disease; EASL, European Association for the Study of the Liver; APASL, the Asian Pacific Association for the Study of the Liver; HBV, hepatitis B virus; ALT, alanine aminotransferase; CHB, chronic hepatitis B; HBsAg, hepatitis B surface antigen; IgG, immunoglobulin G; anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface antigen; tenofovir DF, tenofovir disoproxil fumarate; tenofovir AF, tenofovir alafenamide.

Table 2

Risk of HBV Reactivation Associated with Immunosuppressive Therapies (Modified from Korean Association for the Study of the Liver (KASL)3, Loomba and Liang9, and Reddy et al.16)

kjg-74-258-i002

◆, high risk (≥10%); ◈, moderate risk (1–10%); ◇, low risk (<1%).

HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; anti-HBc, antibody to hepatitis B core antigen; TNF-α, tumor necrosis factor-α.

Table 3

Reported Risks of HBV Reactivation during Immunosuppressive Treatment in High Risk Groups

kjg-74-258-i003

HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; IgG, immunoglobulin G; anti-HBc, antibody to hepatitis B core antigen; RR, relative risk ratio; CI, confidence interval; TNF-α, tumor necrosis factor-α: DMARDs, disease-modifying antirheumatic drugs.

Notes

Financial support None.

Conflict of interest None.

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Eileen L. Yoon
https://orcid.org/0000-0003-0474-048X

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