Zannella Alessandra, Marignani Massimo, Begini Paola
Digestive and Liver Diseases Department, Liver Diseases Section, AOU Sant'Andrea Hospital, 00189 Rome, Italy.
School of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
Viruses. 2019 Sep 14;11(9):858. doi: 10.3390/v11090858.
It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.
众所周知，乙型肝炎病毒再激活（HBVr）可发生在接受血液系统恶性肿瘤（HM）治疗的患者中。对接受免疫抑制治疗的患者进行HBVr风险评估是一个多维度的过程，包括准确的临床病史和体格检查、对病毒学类别、用于治疗这些血液系统恶性肿瘤的药物以及所诱导的免疫抑制程度的考虑。一旦确定了再激活风险，采取适当的管理策略（如果发生再激活）至关重要。治疗的目的是预防HBVr的严重临床后果，如急性/暴发性肝炎和肝衰竭。将根据当前国际建议提供的指征和证据进行治疗，并防止危及生命的抗肿瘤治疗中断。在本文中，我们将介绍关于这一特殊免疫抑制患者群体中HBVr风险的现有数据，并探讨有效预防和管理这一潜在危及生命事件的相关性。使用适当的术语进行了计算机文献检索以发现相关文章。目前的证据支持对计划接受血液系统恶性肿瘤治疗的患者进行普遍HBV检测的政策，临床医生应意识到不同病毒学类别和免疫抑制药物类别中病毒再激活的固有风险。
