Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5769-5781
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5769
Prevention of hepatitis B reactivation in patients requiring chemotherapy and immunosuppressive therapy
Chih-An Shih, Wen-Chi Chen
Chih-An Shih, Wen-Chi Chen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Chih-An Shih, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung County 928, Taiwan
Chih-An Shih, Department of Nursing, Meiho University, Pingtung County 928, Taiwan
Wen-Chi Chen, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
Wen-Chi Chen, Institute of Biomedical Sciences, College of Science, National Sun Yat-sen University, Kaohsiung 8424, Taiwan
Author contributions: Shih CA and Chen WC designed the research study, performed the research and wrote the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare having 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:
Corresponding author: Wen-Chi Chen, MD, Chief Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 29, 2021
Revised: April 12, 2021
Accepted: June 2, 2021
Article in press: June 2, 2021
Published online: July 26, 2021

Hepatitis B virus (HBV) reactivation can lead to severe acute hepatic failure and death in patients with HBV infection. HBV reactivation (HBVr) most commonly develops in patients undergoing cancer chemotherapy, especially B cell-depleting agent therapy such as rituximab and ofatumumab for hematological or solid organ malignancies and that receiving hematopoietic stem cell transplantation without antiviral prophylaxis. In addition, the potential consequences of HBVr is particularly a concern when patients are exposed to either immunosuppressive or biologic therapies for the management of rheumatologic diseases, inflammatory bowel disease and dermatologic diseases. Thus, screening with HBV serological markers and prophylactic or pre-emptive antiviral treatment with nucleos(t)ide analogues should be considered in these patients to diminish the risk of HBVr. This review discusses the clinical manifestation, prognosis and management of HBVr, risk stratifications of cancer chemotherapy and immunosuppressive therapy and international guideline recommendations for the prevention of HBVr in patients with HBV infection and resolved hepatitis B.

Keywords: Hepatitis B virus, Reactivation, Chemotherapy, Immunosuppression, Prevention

Core Tip: Reactivation of hepatitis B virus (HBV) could be fatal in the patients with hepatitis B infection and chemotherapy or immunosuppressive therapy. We review the risk of HBV reactivation, screening of HBV infection and the strategies of prophylaxis of HBV reactivation in patients requiring chemotherapy and immunosuppressive therapy.