Hepatitis B Virus Reactivation: Risk Factors and Current Management Strategies

Abstract

Hepatitis B virus (HBV) is a global disease with significant morbidity and mortality. Worldwide,~257 million people are chronically infected with HBV, defined as having a positive hepatitis B surface antigen, but millions more have prior HBV exposure indicated by positive hepatitis B core antibody. Reactivation of hepatitis B implies a sudden increase in viral replication in a patient with chronic HBV infection or prior HBV exposure. Hepatitis B virus reactivation (HBVr) can occur spontaneously, but it is more commonly triggered by immunosuppressive therapies for cancer, immunologic diseases, or transplantation. Elimination of hepatitis C virus (HCV) in HBV-HCV coinfected individuals treated with direct-acting antivirals (DAAs) has also been identified as an important cause of HBVr. Hepatitis B virus reactivation is an underappreciated but important complication of common medical therapies that can delay treatment or result in clinical episodes of hepatitis, hepatic failure, or death. In this review, factors associated with HBVr, particularly medication-related risks, are explored. We review data involving rituximab and ofatumumab, doxorubicin, corticosteroids, tumor necrosis factor antagonists, tyrosine kinases, bortezomib, hematologic stem cell transplantation, and DAAs for HCV treatment. In addition, we discuss screening strategies, choice of antiviral prophylaxis, and the optimal duration of therapy for HBVr. With additional awareness, screening, and appropriate antiviral therapy, it is expected that most cases of HBVr can be prevented.

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

“…Moreover, these drugs appear to be independent predictors of infection-related hospitalization [32]. Although most of the GC-related reported infections are bacterial, viral infections have been reported too, primarily represented by HSV and HBV reactivation [25,33]. The most debating question is the possible usage of GCs during COVID-19 pandemic and, in case, which, at which disease stage, and at which dosage/administration route.…”

Clearance of HBsAg in a patient with familial multiple myeloma after a bortezomib-based regimen combined with anti-HBV drug

“…Patients of multiple myeloma patients are usually immunocompromised, which can also lead to reactivation of HBV. [31] The multiple myeloma in our patient was quickly controlled after initiating the PCD regimen and the improved immune status might also be one of the factors aiding the clearance of HBV. The effect of bortezomib on HBV is influenced by many factors; however, the detailed mechanism is still not understood.…”

Monoclonal Antibody Therapies for Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder

“…67 In 2013, boxed warnings were added to the product labels for rituximab and ofatumumab that identified these agents as being associated with a high risk of HBV reactivation. 68 The European Association for the Study of the Liver recommended that Abs against hepatitis B core antigen should be tested for before initiating treatment with rituximab, with prophylactic antiviral therapy given during treatment and for a prolonged period afterward if necessary. 69 PML associated with rituximab has been reported not in patients with MS or NMOSD but in patients with lymphoma, rheumatoid arthritis (RA), and lupus who received other immunosuppressive treatments in addition to rituximab.…”