Management of HBV Infection During Immunosuppresive Treatment

Abstract

The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Currently, a rational approach to the problem of hepatitis B in these patients provides for: a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), b) the treatment with antivirals (therapy) of active carriers, c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, d) the biochemical and HBsAg monitoring (or universal prophylaxis in case of high risk immunosuppression, as in onco-haematologic patients and bone marrow transplantation) in subjects with markers of previous contact with HBV (HBsAg-negative and antiHBc-positive), in order to prevent reverse seroconversion. Moreover in solid organ transplants it is suggested a strict adherence to the criteria of allocation based on the virological characteristics of both recipients and donors and the universal prophylaxis or therapy with nucleos(t)ides analogs

Renal grafts from anti‐hepatitis B core‐positive donors: a quantitative review of the literature

“…Given the low risk of HBV transmission from anti‐HBc‐positive kidney donors to the recipients, implementing anti‐HBV prophylaxis in all recipients does not seem reasonable. However, the patients who develop inactive carrier status (HBeAg negative and anti‐HBe positive, whose alanine aminotransferase [ALT] levels are persistently within the normal range and HBV DNA < 2000 IU/mL) as well as the patients who become chronic carriers with active HBV replication (HBV DNA > 2000 IU/mL) should be treated as immunocompetent patients with nucleoside analogs with high potency and low resistance, such as entecavir or tenofovir . HBIg plays no role in treatment of HBV infection in immunocompetent and immunocompromised patients.…”

“…Interferon preparations (pegylated and standard) are contraindicated in renal transplant patients because of the high risk of rejection. Once nucleoside analog therapy or prophylaxis starts, response‐to‐therapy evaluation will be necessary through serum HBV DNA and ALT levels every 3 months .…”

Psoriasis, hepatitis B, and the tumor necrosis factor-alpha inhibitory agents: A review and recommendations for management

“…60 It is generally considered that to be optimally effective, an antiviral should be given pre-emptively, either 2 to 4 weeks before or concomitant with the start of immunosuppressive therapy. 4,[61][62][63][64][65] There are insufficient data at the current time, however, to indicate whether routine use of pre-emptive therapy is required for all patients undergoing TNF-alpha inhibitor therapy or whether this is cost-effective. Further studies are warranted.…”

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

“…This approach was strongly indicated in patients with signs of advanced liver damage (chronic hepatitis/cirrhosis, either HBV-related or not). This strategy was also recommended in case of positive serum HBVDNA and/or positivity for antiHBe antibodies at baseline evaluation and, more recently, independently from anti-HBs reactivity [74] . In case of UP, LAM is preferred for short term therapies [74] , given its lower cost and efficacy in these patients with very low or absent viral replication.…”