Hospital Selayang, Acute Internal Medicine, Malaysia.
Hospital Selayang, Department of Hepatology, Malaysia.
Med J Malaysia. 2021 Sep;76(5):719-724.
This case series is to create awareness among clinicians on the importance of Hepatitis B screening prior to administration of chemotherapeutic agents and immunosuppressant in preventing Hepatitis B reactivation (HBVr). We also highlight the importance of identifying patients who are at risk of HBVr and when to initiate antiviral prophylaxis based on the current evidence-based guidelines. The case series consists of four patients seen in Hospital Selayang, Malaysia who developed fulminant liver failure secondary to chemotherapeutic agents or immunosuppressant induced HBVr. HBVr is likely to be of increasing clinical significance as potent immunosuppressive regimens are used more widely across all medical specialties. Clinicians should be made aware of the potential risk of patients developing fulminant liver failure following HBVr and its association with high morbidity and mortality. In the era of inexpensive Hepatitis B blood screening tests and safe potent antivirals, there is now a paradigm shift to make the test compulsory to screen all patient prior to initiation of chemotherapeutic agents or immunosuppressive therapy. Antiviral prophylaxis may be offered to more patients who are at risk of HBVr and the duration of both prophylaxis and subsequent monitoring may be extended until 6 to 18 months following completion of treatment.
本病例系列旨在提高临床医生的认识，即在使用化疗药物和免疫抑制剂之前，应进行乙型肝炎筛查，以预防乙型肝炎病毒再激活（HBVr）。我们还强调了根据当前循证指南确定有 HBVr 风险的患者以及何时开始抗病毒预防的重要性。该病例系列包括马来西亚赛城医院的 4 名患者，他们因化疗药物或免疫抑制剂诱导的 HBVr 导致暴发性肝衰竭。随着广泛应用于各个医学专业的强效免疫抑制方案，HBVr 可能具有越来越重要的临床意义。临床医生应该意识到患者在发生 HBVr 后发生暴发性肝衰竭的潜在风险及其与高发病率和死亡率的关联。在乙型肝炎血液筛查检测价格低廉且安全有效的抗病毒药物的时代，现在已经出现了一种范式转变，即要求在开始化疗药物或免疫抑制治疗之前，对所有患者进行强制性检测。可以为更多有 HBVr 风险的患者提供抗病毒预防措施，并且预防和随后的监测时间可能会延长至治疗完成后 6 至 18 个月。
