Risk and Prevention of Hepatitis B Virus Reactivation during Immunosuppression for Non-Oncological Diseases

Abstract

Reactivation of overt or occult HBV infection (HBVr) is a well-known, potentially life-threatening event which can occur during the course of immunosuppressive treatments. Although it has been described mainly in subjects receiving therapy for oncological or hematological diseases, the increasing use of immunosuppressant agents in non-oncological patients observed in recent years has raised concerns about the risk of reactivation in several other settings. However, few data can be found in the literature on the occurrence of HBVr in these populations, and few clear recommendations on its management have been defined. The present paper was written to provide an overview of the risk of HBV reactivation in non-neoplastic patients treated with immunosuppressive drugs, particularly for rheumatological, gastrointestinal, dermatological and neurological diseases, and for COVID-19 patients receiving immunomodulating agents; and to discuss the potential strategies for prevention and treatment of HBVr in these settings.

Reactivation of Occult Hepatitis B Virus Infection During Long-Term Entecavir Antiviral Therapy

“…OBI may result in HBV reactivation (HBVr), acute exacerbations, cirrhosis, and hepatocellular carcinoma (HCC; Mak et al, 2020 ). For OBI patients or HBV exposure (HBsAg-negative but HBcAb-positive; Pattullo, 2015 ), according to the recent American Association for the Study of Liver Diseases (AASLD) recommendation guideline, HBVr could be defined as (1) HBV DNA is detectable; or (2) reverse HBsAg seroconversion occurs (reappearance of HBsAg; Terrault et al, 2018 ; Onorato et al, 2021 ).…”

Liver Dysfunction in COVID-19: From Onset to Recovery

“…60 However, immunosuppression drugs, adopted for the treatment of COVID-19 in some patients, might increase the risk of HBV reactivation. 61 These immunosuppression drugs include corticosteroids and interleukin-6 (IL-6) inhibitors. Long-term (≥ 4 weeks) use of moderate dose (10–20 mg prednisolone equivalents) or high dose (≥ 20 mg prednisolone equivalents) corticosteroids, even short course (≤ 1 week) use of high dose (> 40 mg prednisolone equivalents) corticosteroids were associated with increased risk of HBV reactivation.…”

“…64 Thus, all patients expected to be treated with corticosteroids for more than 7 to 10 days or with other immunosuppressive drugs for COVID-19 pneumonia should be screened for current and previous HBV infections. 61 Antiviral prophylaxis is warranted for patients in high risk of HBV reactivation.…”

Chronic hepatitis B in rheumatic diseases: issues of screening and reactivation of infection: A review

“…(2021 г.) суммировали результаты когортных исследований, проведенных в 2013-2020 гг., и наглядно показали, что при проведении ИСТ, даже с ис-пользованием препаратов умеренного риска, вероятность HBV-r наиболее высока у пациентов с HBSAg(+), не получающих ПВП [54].…”