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Copyright ©The Author(s) 2022.
World J Clin Cases. Jan 7, 2022; 10(1): 12-22
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.12
Table 1 Risk of hepatitis B virus reactivation with different immunosuppressants
Medication
Mechanism
Definition of HBV reactivation
Study population
Reactivation rate
MethotrexateSuppressive HBV specific cytotoxic T cell response and the production of proinflammatory cytokinesHBV DNA > 103 (copies/mL)HBsAg-positiveLow risk[29,30]
HBsAg-negativeLow risk[30]
LeflunomideInhibition of the growth of activated lymphocytes by inhibition of dihydro-lactate dehydrogenase10-fold rise in HBV-DNA compared to baseline or a switch from undetectable to detectableHBsAg-positiveHigh risk, contraindicated[31]
HBsAg-negativeNo data
CorticosteroidsImmunomodulatory and anti-inflammatorySwitch from undetectable HBV DNA to detectable or a 10-fold increase compared with baseline[34]HBsAg-positiveHigh risk (> 10 mg, > 4 wk); medium risk (< 10 mg, > 4 wk); low risk (< 10 mg, < 1 wk)
HBsAg-negative1%-1.8%[34,36]
TNF inhibitorDampening of the cytokine cascade and suppression of the cytotoxic CD8+ T-cell responses against HBVAn increase of serum HBV DNA levels by greater than 1 logs10 IU/mL or conversion from HBsAg- to HBsAg+HBsAg-positiveMedium-high risk (9.1%-75%)[23,38]
HBsAg-negativeLow risk (0-8.3%)[22,39]
TocilizumabBlocks IL-6 signaling by inhibiting its receptorHBV-DNA level higher than 2.0 log copies/mLHBsAg-positiveNo data
HBsAg-negativeLow risk (8%)[40]
TofacitinibInhibition of JAK signal pathwayAn increase in HBV DNA by greater than 1 to 2 logs10 IU/mL or a reappearance of HBsAgHBsAg-positiveHigh risk (100%)[41]
HBsAg-negativeLow risk (0)
AbataceptBlocks co-stimulation of T lymphocytes Conversion from HBsAg- to HBsAg+HBsAg-positiveMedium risk[34]
HBsAg-negativeLow risk[34]
Table 2 Characteristics of different phases of hepatitis B virus infection




HBsAg
Anti-HBs
HBeAg
Anti-HBe
Anti-HBc
HBV DNA
ALT
HBV seronegative-+/-----Normal
HBV infectionPhase 1Chronic HBV infection+-+-+> 20000 IU/mLNormal
Phase 2CHBHBeAg(+)+-+-+> 20000 IU/mL> 2 ULN
Phase 4CHBHBeAg(-)+--++> 2000 IU/mL> 2 ULN
Phase 3Inactive HBsAg carrier+--+/-+< 2000 IU/mLNormal
Phase 5Resolved infection-+/--++-Normal