Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2015; 7(7): 954-967
Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.954
Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure
Venessa Pattullo
Venessa Pattullo, Department of Gastroenterology, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia
Venessa Pattullo, Sydney Medical School, University of Sydney, Sydney NSW 2006, Australia
Author contributions: Pattullo V solely contributed to this manuscript.
Conflict-of-interest: Venessa Pattullo has received fees for serving as a speaker from Janssen, Merck-Sharpe Dohme and Gilead within the last 5 years (content approved by independent steering committees). There are no other potential conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an 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:
Correspondence to: Dr. Venessa Pattullo, MBBS, FRACP, PhD, Department of Gastroenterology, Royal North Shore Hospital, 4B Acute Services Building, St Leonards NSW 2065, Sydney, Australia.
Telephone: +61-2-94632450 Fax: +61-2-94632041
Received: December 2, 2014
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
Core Tip

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.