Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China.
Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
Hepatol Int. 2022 Apr;16(2):257-268. doi: 10.1007/s12072-022-10306-x. Epub 2022 Mar 2.
The world has made significant progress in developing novel treatments for COVID-19 since the pandemic began. Some treatments target the patient's dysregulated inflammatory response during COVID-19 infection and may cause hepatitis B reactivation (HBVr) in patients with current or past hepatitis B virus (HBV) infection. This review summarizes the risk and management of HBVr due to different treatments of COVID-19 in patients who have current or past HBV infection. Abnormal liver function tests are common during COVID-19 infection. Current evidence suggests that current or past HBV infection is not associated with an increased risk of liver injury and severe disease in COVID-19 patients. Among patients who received high-dose corticosteroids, various immunosuppressive monoclonal antibodies and inhibitors of Janus kinase, the risk of HBVr exists, especially among those without antiviral prophylaxis. Data, however, remain scarce regarding the specific use of immunosuppressive therapies in COVID-19 patients with HBV infection. Some results are mainly extrapolated from patients receiving the same agents in other diseases. HBVr is a potentially life-threatening event following profound immunosuppression by COVID-19 therapies. Future studies should explore the use of immunosuppressive therapies in COVID-19 patients with HBV infection and the impact of antiviral prophylaxis on the risk of HBVr.
自新冠疫情爆发以来，全球在研发新冠病毒治疗方法方面取得了重大进展。部分治疗方法针对的是新冠病毒感染期间患者失调的炎症反应，可能会导致现症或既往乙型肝炎病毒（HBV）感染者出现乙型肝炎病毒再激活（HBVr）。本综述总结了在现症或既往 HBV 感染者中，因新冠病毒不同治疗方法而导致 HBVr 的风险和管理。在新冠病毒感染期间，肝功能检查异常较为常见。目前的证据表明，现症或既往 HBV 感染与新冠病毒患者的肝损伤和重症风险增加无关。在接受高剂量皮质类固醇、各种免疫抑制单克隆抗体和 Janus 激酶抑制剂治疗的患者中，存在 HBVr 的风险，尤其是在未进行抗病毒预防的患者中。然而，关于 HBV 感染的新冠病毒患者中免疫抑制治疗的具体使用，数据仍然有限。一些结果主要是从接受其他疾病中相同药物治疗的患者中推断出来的。HBVr 是新冠病毒治疗导致严重免疫抑制后的潜在危及生命的事件。未来的研究应探索在 HBV 感染的新冠病毒患者中使用免疫抑制治疗的情况，以及抗病毒预防对 HBVr 风险的影响。
