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World J Virol. Sep 25, 2022; 11(5): 275-282
Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.275
Hepatitis B virus infection reactivation in patients under immunosuppressive therapies: Pathogenesis, screening, prevention and treatment
Anna Maria Spera
Anna Maria Spera, Infectious Disease Unit, Universitary Hospital OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno 84131, Italy
Author contributions: Spera AM study conception and design; data collection; analysis and interpretation of results; draft manuscript preparation; Spera AM finally reviewed the results and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Maria Spera, Doctor, PhD, Doctor, Postdoctoral Fellow, Infectious Disease Unit, Universitary Hospital OORR San Giovanni di Dio e Ruggi d'Aragona, Largo Ippocrate, Salerno 84131, Italy. annamariaspera@hotmail.it
Received: March 18, 2022
Peer-review started: March 18, 2022
First decision: May 12, 2022
Revised: May 20, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: September 25, 2022
Processing time: 189 Days and 20.7 Hours
Abstract

With a 5.3% of the global population involved, hepatitis B virus (HBV) is a major public health challenge requiring an urgent response. After a possible acute phase, the natural history of HBV infection can progress in chronicity. Patients with overt or occult HBV infection can undergo HBV reactivation (HBVr) in course of immunosuppressive treatments that, apart from oncological and hem-atological diseases, are also used in rheumatologic, gastrointestinal, neurological and dermatological settings, as well as to treat severe acute respiratory syndrome coronavirus 2 infection. The risk of HBV reactivation is related to the immune status of the patient and the baseline HBV infection condition. The aim of the present paper is to investigate the risk of HBVr in those not oncological settings in order to suggest strategies for preventing and treating this occurrence. The main studies about HBVr for patients with occult hepatitis B infection and chronic HBV infection affected by non-oncologic diseases eligible for immunosuppressive treatment have been analyzed. The occurrence of this challenging event can be reduced screening the population eligible for immunosuppressant to assess the best strategies according to any virological status. Further prospective studies are needed to increase data on the risk of HBVr related to newer immunomodulant agents employed in non-oncological setting.

Keywords: Hepatitis B Virus infection; Reactivation; Occult B infection; Chronic B infection; Immunosuppression; Disease-modifying antirheumatic drugs

Core Tip: Hepatitis B Virus (HBV) is a major public health challenge requiring an urgent response. Patients with overt or occult HBV infection can undergo HBV reactivation (HBVr) in course of immu-nosuppressive treatments, also used in rheumatologic, gastrointestinal, neurological and dermatological settings and to treat Sars severe acute respiratory syndrome coronavirus 2 infection. The aim of the present paper is to investigate the risk of HBVr in those not oncological settings in order to suggest strategies for preventing and treating this occurrence. The occurrence of this challenging event can be reduced screening the population eligible for immunosuppressant to assess the best strategies according to any virological status.