HBV treatment in a patient who will be receiving immunosuppressive therapy

Abstract

Despite an effective vaccine, hepatitis B virus (HBV) infection remains an enormous global public health problem with up to 400 million people chronically infected and as many as 2 billion people with evidence of exposure to the virus worldwide. 1,2 The virus is noncytopathic, with hepatic injury occurring as a result of the host immune response against the virus. 1 As a result, the interaction between HBV and the immune system is critical in determining the outcome of infection.After perinatal or early childhood infection, >90% of individuals will progress to chronic infection, initially characterized by normal liver tests and histology despite high levels of HBV replication, the so-called immunotolerant phase of infection. 2 Patients eventually develop an immune response against HBV, leading to flares of hepatitis with the potential for progressive liver damage. Ultimately, most immunocompetent patients will gain immune control of HBV, with suppression of viral replication, normalization of liver enzymes, and loss of circulating HBeAg. 2 Persistence of this inactive carrier state depends on immune function. Even those with undetectable HBV DNA in the serum continue to harbor replication-competent HBV in infected liver cells. With immunosuppression, immune control may be lost, resulting in reactivation of HBV replication with the potential for severe flares of hepatitis, often at the time of restoration of immune function. Reactivation has variable clinical consequences ranging from asymptomatic increases in serum HBV DNA to potentially fulminant and even fatal flares of hepatitis. 3,4 Reactivation may also lead to interruptions or premature discontinuation of immunosuppressive therapy, including cancer chemotherapy with potential negative consequences. 5

Correlation of Quantitative Assay of HBsAg and Hepatitis B Virus DNA Levels Among Chronic HBV Patients Attending Pathologist Lancet Laboratory in Nairobi, Kenya

“…Despite the availability of an effective vaccine and potent antiviral treatments, hepatitis B virus (HBV) infection is still a major global health problem (1,2). By 2015, approximately 2 billion individuals had been exposed to HBV, with nearly 257 million estimated cases of chronic hepatitis B infection (3).…”

“…By 2015, approximately 2 billion individuals had been exposed to HBV, with nearly 257 million estimated cases of chronic hepatitis B infection (3). Hepatitis B Virus and related conditions are also thought to be responsible for 500,000 to 700,000 deaths, annually (2). It is highly endemic in sub-Saharan Africa and East Asia, where approximately 5% to 10% of the adult population is chronically infected (4).…”

Hepatitis B Virus Belated Reverse Sero-conversion After Hematopoietic Stem Cell Transplantation or Rituximab Chemotherapy

“…Most relevant factors to trigger HBV reverse sero-conversion are HSCT and rituximab based chemotherapy regiments [11] . Apart from the human immunodeficiency virus infected individuals, almost all patients with HBV reverse sero-conversion in the literature have a previous history of HSCT or rituximab based chemotherapy regiments administration.…”

The Impact of Biologics for the Management of Inflammatory Bowel Disease on Liver Enzymes

“…Impact of Biologics for IBD on Liver Enzymes Aby, Lake, and Vaughn review prophylactic antiviral therapy, such as lamivudine, tenofovir, or entecavir, prior to initiation of TNF-α inhibitors. 9 Patients who are HBsAg negative but antibody to hepatitis B core antigen (anti-HBc) positive should be monitored closely for reactivation. Newer biologics may not have the same risk for HBV reactivation, although screening based on individual risk factors likely remains prudent.…”

“…Therefore, patients should be screened for HBV with hepatitis B surface antigen (HBsAg), anti‐hepatitis B core antigen, and anti‐HBsAg prior to starting an anti‐TNF 8 . Patients who are HBsAg positive are more likely to experience hepatitis B reactivation, and thus should receive prophylactic antiviral therapy, such as lamivudine, tenofovir, or entecavir, prior to initiation of TNF‐α inhibitors 9 . Patients who are HBsAg negative but antibody to hepatitis B core antigen (anti‐HBc) positive should be monitored closely for reactivation.…”