Feld Jordan J
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, ON, Canada.
Dig Dis. 2017;35(4):351-358. doi: 10.1159/000456587. Epub 2017 May 3.
Hepatitis B virus (HBV) reactivation is a serious but largely avoidable complication of immunosuppressive therapy. The consequences of reactivation range from subclinical increases in HBV DNA to fulminant liver failure, which can be prevented with the appropriate use of prophylactic antiviral therapy. However, which patients need to be screened and whether all patients who test positive for any serological test require antiviral therapy are issues that still remain unclear. Additional issues such as the choice of antiviral and the duration of treatment also need clarification. Some of the confusion comes from the use of varying definitions in the literature to define outcomes. In this review, areas of controversy from definitions of reactivation to management of patients who are hepatitis B surface antigen and lone anti-core antibody positive in different clinical settings are discussed. The recently recognized issue of reactivation in the setting of hepatitis C antiviral therapy is also addressed as well as some recommendations for areas of future research to help clarify best practices.
乙型肝炎病毒（HBV）再激活是免疫抑制治疗一种严重但在很大程度上可避免的并发症。再激活的后果从HBV DNA的亚临床升高到暴发性肝衰竭不等，适当使用预防性抗病毒治疗可预防这些后果。然而，哪些患者需要筛查以及所有血清学检测呈阳性的患者是否都需要抗病毒治疗仍是尚不清楚的问题。抗病毒药物的选择和治疗持续时间等其他问题也需要阐明。部分困惑源于文献中使用不同定义来界定结果。在本综述中，我们讨论了从再激活定义到不同临床环境中乙型肝炎表面抗原和单纯抗核心抗体阳性患者管理等争议领域。还讨论了丙型肝炎抗病毒治疗背景下最近认识到的再激活问题以及对未来研究领域的一些建议，以帮助阐明最佳实践。
