Seetharam Anil, Perrillo Robert, Gish Robert
Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ USA ; University of Arizona College of Medicine, Phoenix, AZ USA.
Hepatology Division, Baylor University Medical Center, Dallas, TX USA ; Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX USA.
Curr Hepatol Rep. 2014 Jun 21;13(3):235-244. doi: 10.1007/s11901-014-0238-2. eCollection 2014.
After hepatitis B virus (HBV) infection, HBV DNA persists in minute amounts in hepatocyte nuclei even in individuals with "resolved" infection. Viral replication and development of liver disease depend on the balance between viral mechanisms promoting persistence and host immune control. Patients with active or inactive disease or resolved HBV infection are at risk for reactivation with immunosuppressive therapy use. HBV reactivation varies from a clinically asymptomatic condition to one associated with acute liver failure and death. We review recent studies on HBV reactivation during immunomodulatory therapies for oncologic, gastroenterological, rheumatic, and dermatologic disorders. Risk calculation should be determined through HBV screening and assessment of immunosuppressive therapy potency. We also discuss monitoring for reactivation, prophylactic antiviral therapy, and treatment of reactivation. Prophylactic antiviral treatment is needed for all HBsAg carriers and selected patients who have anti-HBc without HBsAg and is critical for preventing viral reactivation and improving outcomes.
乙型肝炎病毒（HBV）感染后，即使在感染已“痊愈”的个体中，HBV DNA仍以微量形式持续存在于肝细胞核中。病毒复制和肝病的发展取决于促进病毒持续存在的病毒机制与宿主免疫控制之间的平衡。正在接受免疫抑制治疗的活动性或非活动性疾病患者或HBV感染已痊愈的患者有病毒再激活的风险。HBV再激活的情况从临床上无症状到与急性肝衰竭及死亡相关不等。我们回顾了近期关于肿瘤、胃肠、风湿和皮肤病免疫调节治疗期间HBV再激活的研究。应通过HBV筛查和免疫抑制治疗效力评估来确定风险计算。我们还讨论了再激活的监测、预防性抗病毒治疗以及再激活的治疗。所有HBsAg携带者以及部分抗-HBc阳性但无HBsAg的患者都需要进行预防性抗病毒治疗，这对于预防病毒再激活和改善治疗结果至关重要。
