Liver Transplantation in Hepatitis B Reactivation in a Patient With Active HIV Viremia

Hegazy, Yassmin; Reif, Meagan; McGuire, Brenden M; Cannon, Robert M.; Orandi, Babak J.; Shoreibah, Mohamed

doi:10.14309/crj.0000000000000943

Cited by 1 publication

(1 citation statement)

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“…There are limited data on the efficacy of antiviral treatment at preventing morbidity and mortality related to HBV reactivation, though one review estimated the survival rate of patients who progress to liver failure at <20% [47,48]. Similarly, data regarding liver transplant in the case of acute or acute on chronic liver failure in this population are limited to case reports [49,50], possibly because members of the at-risk population often have other contraindications to transplant, such as active malignancy. In patients with suspected hepatitis related to HBV reactivation, other causes of elevated liver enzymes should be ruled out.…”

Section: Treatment Of Hbv Reactivationmentioning

confidence: 99%

Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat?

Anvari,

Tsoi

2024

JCM

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Hepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article was to review the literature on risks of HBV reactivation associated with immunosuppressive agents and propose a management algorithm. We searched Google Scholar, PubMed, and MEDLINE for studies related to hepatitis B reactivation and various immunosuppressive agents. The risk of HBV reactivation was found to differ by agent and depending on whether a patient had chronic HBV (HBsAg+) or past HBV (HBsAg−, anti-HBc+). The highest risk of reactivation (>10%) was associated with anti-CD20 agents and hematopoietic stem cell transplants. Multiple societies recommend HBV-specific anti-viral prophylaxis for patients with positive HBsAg prior to the initiation of immunosuppressive therapy, while the guidance for HBsAg− patients is more variable. Clinicians should check HBV status prior to beginning an immune-suppressive therapy. Patients with positive HBsAg should be initiated on antiviral prophylaxis in the majority of cases, whereas HBsAg− individuals should be evaluated on a case-by-case basis. Further research is required to determine the optimum duration of therapy.

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