Coluccio Chiara, Begini Paola, Marzano Alfredo, Pellicelli Adriano, Imperatrice Barbara, Anania Giulia, Delle Fave Gianfranco, Marignani Massimo
Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, 10126 Turin, Italy.
World J Hepatol. 2017 Sep 8;9(25):1043-1053. doi: 10.4254/wjh.v9.i25.1043.
Hepatitis B virus (HBV) reactivation (HBVr) in patients undergoing immunosuppressive therapy is still a hot topic worldwide. Its prevention and management still represents a challenge for specialists dealing with immunosuppressed patients. Aim of this paper is to provide a critical review of the relevant information emerged in the recent literature regarding HBV reactivation following immunosuppressive treatments for oncohematological tumors. A computerized literature search in MEDLINE was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. Articles published only in abstract form and case reports not giving considerable news were excluded. Clinical manifestation of HBVr can be manifold, ranging from asymptomatic self-limiting anicteric hepatitis to life-threatening fulminant liver failure. In clusters of patients adverse outcomes are potentially predictable. Clinicians should be aware of the inherent risk of HBVr among the different virological categories (active carriers, occult HBV carriers and inactive carriers, the most intriguing category), and classes of immunosuppressive drugs. We recommend that patients undergoing immunosuppressive treatments for hematological malignancies should undergo HBV screening. In case of serological sign(s) of current or past infection with the virus, appropriate therapeutic or preventive strategies are suggested, according to both virological categories, risk of HBVr by immunosuppressive drugs and liver status. Either antiviral drug management and surveillance and pre-emptive approach are examined, commenting the current international recommendations about this debated issue.
接受免疫抑制治疗的患者中乙肝病毒（HBV）再激活（HBVr）仍是全球的热点话题。对于治疗免疫抑制患者的专家而言，其预防和管理仍是一项挑战。本文旨在对近期文献中有关血液肿瘤免疫抑制治疗后HBV再激活的相关信息进行批判性综述。我们使用适当的检索词组合在MEDLINE数据库中进行了计算机化文献检索，仅包括英文撰写的文献或其他相关文章。仅以摘要形式发表的文章以及未提供重要信息的病例报告被排除。HBVr的临床表现多种多样，从无症状自限性无黄疸型肝炎到危及生命的暴发性肝衰竭。在一组患者中，不良结局可能是可预测的。临床医生应了解不同病毒学类别（活跃携带者、隐匿性HBV携带者和非活动性携带者，最具争议的类别）以及免疫抑制药物类别中HBVr的固有风险。我们建议接受血液系统恶性肿瘤免疫抑制治疗的患者应进行HBV筛查。如果出现当前或既往感染该病毒的血清学迹象，应根据病毒学类别、免疫抑制药物导致HBVr的风险以及肝脏状况，建议采取适当的治疗或预防策略。本文探讨了抗病毒药物管理与监测以及抢先治疗方法，并对当前关于这一有争议问题的国际建议进行了评论。
