Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 26, 2021; 9(21): 5769-5781
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5769
Table 1 Immunosuppressive agent classes and corresponding risks of hepatitis B reactivation
Risk group
Seropositive for HBsAg and anti-HBc
Seronegative for HBsAg, seropositive for anti-HBc
High risk (> 10%)Anti-CD20 antibodiesAnti-CD20 antibodies
Anti-CD52 antibodies
Anthracycline derivatives
Costimulation inhibitors
JAK inhibitors
Moderate-high dose corticosteroid therapy1 for ≥ 4 wk
Moderate risk (1%-10%)TNF-α inhibitorsAnthracycline derivatives
Integrin inhibitorsTNF-α inhibitors
IL-12 and IL-23 antibodiesIntegrin inhibitors
Tyrosine kinase inhibitorsIL-12 and IL-23 antibodies
Low dose corticosteroid therapy1 for ≥ 4 wkTyrosine kinase inhibitors
Moderate-high dose corticosteroid therapy1 for ≥ 4 wk
Low risk (< 1%)General immunosuppressive agents (azathioprine, 6-mercaptopurine and methotrexate)General immunosuppressive agents (azathioprine, 6-mercaptopurine and methotrexate)
Corticosteroid therapy1 for ≤ 1 wkLow dose corticosteroid therapy1 for ≥ 4 wk
Intra-articular corticosteroidsCorticosteroid therapy1 for ≤ 1 wk
Intra-articular corticosteroids
Table 2 Recommendations of international guidelines for treatment and follow-up in different clinical scenarios

AASLD 2018
EASL 2017
APASL 2016
AGA 2015
Screening before chemotherapy/immunosuppressive therapyHBsAg and anti-HBcHBsAg, anti-HBc, and anti-HBsHBsAg and anti-HBcHBsAg and anti-HBc
HBV DNA if serology positive
Start antiviral prophylaxis before chemotherapy/immunosuppressive therapyFor HBsAg (+) patientsFor HBsAg (+) patientsFor HBsAg (+) patientsFor HBsAg (+) patients
For HBsAg (-)/anti-HBc (+) patients: if at high risk of HBV reactivationFor HBsAg (-)/anti-HBc (+) patients: if detectable serum HBV DNAFor HBsAg (-)/anti-HBc (+) patients: If the chemotherapy is associated with high or moderate risk of HBV reactivation
Treatment duration of antiviral treatment after completing chemotherapy/immunosuppressive therapyAt least 6 mo 12 mo12 moAt least 6 mo
At least 12 mo for patients receiving anti-CD20 antibodies therapyAt least 12 mo for patient receiving anti-CD20 antibodies therapy
Antivirals of choiceTDF, TAF or ETVTDF, TAF or ETVTDF and ETVTDF and ETV