Published online Sep 8, 2017. doi: 10.4254/wjh.v9.i25.1043
Peer-review started: June 1, 2017
First decision: July 11, 2017
Revised: July 20, 2017
Accepted: August 3, 2017
Article in press: August 4, 2017
Published online: September 8, 2017
Hepatitis B virus (HBV) reactivation (HBVr) in patients undergoing immunosuppressive therapy is still a hot topic worldwide. Its prevention and management still represents a challenge for specialists dealing with immunosuppressed patients. Aim of this paper is to provide a critical review of the relevant information emerged in the recent literature regarding HBV reactivation following immunosuppressive treatments for oncohematological tumors. A computerized literature search in MEDLINE was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. Articles published only in abstract form and case reports not giving considerable news were excluded. Clinical manifestation of HBVr can be manifold, ranging from asymptomatic self-limiting anicteric hepatitis to life-threatening fulminant liver failure. In clusters of patients adverse outcomes are potentially predictable. Clinicians should be aware of the inherent risk of HBVr among the different virological categories (active carriers, occult HBV carriers and inactive carriers, the most intriguing category), and classes of immunosuppressive drugs. We recommend that patients undergoing immunosuppressive treatments for hematological malignancies should undergo HBV screening. In case of serological sign(s) of current or past infection with the virus, appropriate therapeutic or preventive strategies are suggested, according to both virological categories, risk of HBVr by immunosuppressive drugs and liver status. Either antiviral drug management and surveillance and pre-emptive approach are examined, commenting the current international recommendations about this debated issue.
Core tip: Despite the increasing awareness regarding the issue of hepatitis B virus reactivation (HBVr) in patients undergoing immunosuppressive treatments, there are still some many debated items concerning this potentially fatal but preventable complication. Both hepatitis B surface antigen (HBsAg) patients and subjects with serological signs of previous resolved exposure to the virus (HBsAg negative/anti-core antibody positive patients) are at risk of HBVr. Purpose of our work was to analyze the current international literature and dedicate guidelines, providing evidences and strategies that have been proposed to manage these patients.