Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.954
Peer-review started: December 4, 2014
First decision: January 8, 2015
Revised: January 31, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 8, 2015
Due to the inherent relationship between the immune system and the hepatitis B virus (HBV) in exposed and infected individuals, immunomodulation associated with the treatment of solid tumours, haematological malignancies and inflammatory disorders has been linked to HBV reactivation (HBVr). Reactivation of HBV infection in the setting of chemotherapy and immunosuppression may lead to fulminant liver failure and death, but there is a cumulative body of evidence that these are potentially preventable adverse outcomes. As chronic hepatitis B is largely asymptomatic but also endemic worldwide, clinicians caring for patients requiring chemotherapy or immunosuppression need to be vigilant of the potential for HBVr in susceptible individuals. Serological screening and prophylactic and pre-emptive antiviral treatment with a nucleos(t)ide analogue should be considered in appropriate settings. Hepatitis B prevalence is examined in this review article, as are the risks of HBVr in patients receiving chemo- and immunosuppressive therapy. Recommendations regarding screening, monitoring and the role of antiviral prophylaxis are outlined with reference to current international associations’ guidelines and the best available evidence to date.
Core tip: Hepatitis B virus reactivation is a potentially fatal but preventable complication of chemotherapy and immunosuppression. Both chronically infected [hepatitis B surface antigen (HBsAg) positive] and previously exposed (HBsAg negative/anti-HBc positive) patients are susceptible, the risk observed to be strongly associated with the potency of the immunosuppressive drug regime and the baseline virological status. The knowledge gaps that require further investigation in the optimal management of this phenomenon are discussed in this review. Recommendations regarding screening, monitoring and the role of antiviral prophylaxis are outlined with reference to current international associations’ guidelines and the best available evidence to date.