Sperl Jan, Franková Sona, Spicák Julius
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Klin Mikrobiol Infekc Lek. 2010 Aug;16(4):120-3.
In patients with chronic HBV infection, immunosuppressive therapy leads to the loss of immune control of replication and excessive increase of HBV viremia. Reactivation of HBV is usually characterized by ALT activity elevation but it may also cause acute liver failure. In patients with a past history of HBV infection (anti-HBc positive), the virus persists in liver cells and may lead to HBV recurrence with identical manifestation. Reactivation and recurrence of hepatitis B may be induced not only by immunosuppressive therapy, but also by anti-CD20 or anti-TNFa treatment. In inactive HBsAg carriers, HBV recurrence and reactivation may be prevented by prophylactic antiviral therapy with lamivudine or other synthetic antivirals (tenofovir, entecavir). Patients who underwent HBV infection in the past should be closely monitored and the treatment should be started when viremia increases. In chronic HCV infection, viremia also increases due to immunosuppression, progression of liver fibrosis is accelerated, but fulminant liver failure is rare. In HCV infected patients, preemptive antiviral treatment cannot be used. In immunocompromised patients, therapy with peginterferon alpha should be indicated individually. Kidney transplant candidates should undergo antiviral treatment before kidney transplantation, during the hemodialysis period.
在慢性乙型肝炎病毒（HBV）感染患者中，免疫抑制治疗会导致对病毒复制的免疫控制丧失以及HBV病毒血症过度增加。HBV再激活通常表现为丙氨酸氨基转移酶（ALT）活性升高，但也可能导致急性肝衰竭。在有HBV感染既往史（抗-HBc阳性）的患者中，病毒持续存在于肝细胞中，并可能导致表现相同的HBV复发。乙型肝炎的再激活和复发不仅可由免疫抑制治疗诱发，也可由抗CD20或抗TNFα治疗诱发。在HBsAg携带者中，使用拉米夫定或其他合成抗病毒药物（替诺福韦、恩替卡韦）进行预防性抗病毒治疗可预防HBV复发和再激活。既往有HBV感染的患者应密切监测，当病毒血症增加时应开始治疗。在慢性丙型肝炎病毒（HCV）感染中，由于免疫抑制病毒血症也会增加，肝纤维化进展加速，但暴发性肝衰竭罕见。在HCV感染患者中，不能采用抢先抗病毒治疗。在免疫功能低下的患者中，聚乙二醇化干扰素α治疗应个体化。肾移植候选者在肾移植前、血液透析期间应接受抗病毒治疗。
