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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2019; 25(26): 3299-3312
Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3299
Reactivation of hepatitis B virus infection in patients with hemo-lymphoproliferative diseases, and its prevention
Caterina Sagnelli, Mariantonietta Pisaturo, Federica Calò, Salvatore Martini, Evangelista Sagnelli, Nicola Coppola
Caterina Sagnelli, Mariantonietta Pisaturo, Federica Calò, Salvatore Martini, Evangelista Sagnelli, Nicola Coppola, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80127, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the authors of the manuscript declare that they have no conflict of interest regarding this paper.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Caterina Sagnelli, MD, PhD, Associate Professor, Chief Doctor, Reader (Associate Professor), Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, Naples 80127, Italy. sagnelli.caterina@libero.it
Telephone: +39-81-5666719 Fax: +39-81-5666207
Received: March 17, 2019
Peer-review started: March 18, 2019
First decision: April 16, 2019
Revised: May 10, 2019
Accepted: May 18, 2019
Article in press: May 18, 2019
Published online: July 14, 2019
Abstract

Reactivation of hepatitis B virus (HBV) replication is characterized by increased HBV-DNA serum values of about 1 log or by HBV DNA turning positive if previously undetectable in serum, possibly associated with liver damage and seldom life-threatening. Due to HBV reactivation, hepatitis B surface antigen (HBsAg)-negative/anti-HBc-positive subjects may revert to HBsAg-positive. In patients with hemo-lymphoproliferative disease, the frequency of HBV reactivation depends on the type of lymphoproliferative disorder, the individual's HBV serological status and the potency and duration of immunosuppression. In particular, it occurs in 10%-50% of the HBsAg-positive and in 2%-25% of the HBsAg- negative/anti-HBc-positive, the highest incidences being registered in patients receiving rituximab-based therapy. HBV reactivation can be prevented by accurate screening of patients at risk and by a pharmacological prophylaxis with anti-HBV nucleo(t)sides starting 2-3 wk before the beginning of immunosuppressive treatment and covering the entire period of administration of immunosuppressive drugs and a long subsequent period, the duration of which depends substantially on the degree of immunodepression achieved. Patients with significant HBV replication before immunosuppressive therapy should receive anti-HBV nucleo(t)sides as a long-term (may be life-long) treatment. This review article is mainly directed to doctors engaged every day in the treatment of patients with onco-lymphoproliferative diseases, so that they can broaden their knowledge on HBV infection and on its reactivation induced by the drugs with high immunosuppressive potential that they use in the care of their patients.

Keywords: Hepatitis B virus reactivation, Hepatitis B virus infection, Hemo-lymphoproliferative diseases, Immunosuppressive therapy, Hepatitis B virus therapy, Hepatitis B virus prophylasis

Core tip: Hepatitis B virus (HBV) reactivation frequently exerts a negative impact on the outcome of patients with hemo-lymphoproliferative disorders both by liver injury, at times severe, and a premature delay or termination of immunosuppressive treatments. Patients at risk should be identified by screening of HBV serum markers before immunosuppressive therapy is started. The use of HBV nucle(t)side analogues, as treatment or prophylaxis, is effective in limiting the frequency and intensity of the damage caused. Antivirals should be administered 2-3 wk before starting immunosuppressive treatment, for the entire immunosuppressive period and during post-treatment follow-up, the length of which depends on the intensity of immunosuppression reached.