Shih Chih-An, Chen Wen-Chi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
World J Clin Cases. 2021 Jul 26;9(21):5769-5781. doi: 10.12998/wjcc.v9.i21.5769.
Hepatitis B virus (HBV) reactivation can lead to severe acute hepatic failure and death in patients with HBV infection. HBV reactivation (HBVr) most commonly develops in patients undergoing cancer chemotherapy, especially B cell-depleting agent therapy such as rituximab and ofatumumab for hematological or solid organ malignancies and that receiving hematopoietic stem cell transplantation without antiviral prophylaxis. In addition, the potential consequences of HBVr is particularly a concern when patients are exposed to either immunosuppressive or biologic therapies for the management of rheumatologic diseases, inflammatory bowel disease and dermatologic diseases. Thus, screening with HBV serological markers and prophylactic or pre-emptive antiviral treatment with nucleos(t)ide analogues should be considered in these patients to diminish the risk of HBVr. This review discusses the clinical manifestation, prognosis and management of HBVr, risk stratifications of cancer chemotherapy and immunosuppressive therapy and international guideline recommendations for the prevention of HBVr in patients with HBV infection and resolved hepatitis B.
乙型肝炎病毒（HBV）再激活可导致HBV感染患者发生严重急性肝衰竭和死亡。HBV再激活（HBVr）最常发生于接受癌症化疗的患者，尤其是用于血液系统或实体器官恶性肿瘤的利妥昔单抗和奥法木单抗等B细胞耗竭剂治疗以及未进行抗病毒预防的造血干细胞移植患者。此外，当患者接受免疫抑制或生物疗法来治疗风湿性疾病、炎症性肠病和皮肤病时，HBVr的潜在后果尤其令人担忧。因此，应考虑对这些患者进行HBV血清学标志物筛查，并使用核苷（酸）类似物进行预防性或抢先性抗病毒治疗，以降低HBVr风险。本综述讨论了HBVr的临床表现、预后和管理、癌症化疗和免疫抑制治疗的风险分层以及预防HBV感染和已治愈乙型肝炎患者发生HBVr的国际指南建议。
