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World J Meta-Anal. May 31, 2019; 7(5): 209-217
Published online May 31, 2019. doi: 10.13105/wjma.v7.i5.209
Hepatitis B reactivation in patients with hepatitis B core antibody positive and surface antigen negative on immunosuppressants
Clement Chun-Ho Wu, Rajneesh Kumar
Clement Chun-Ho Wu, Rajneesh Kumar, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore
Clement Chun-Ho Wu, Rajneesh Kumar, Duke-NUS Medical School, Singapore 169608, Singapore
Author contributions: The authors contributed equally to this work.
Conflict-of-interest statement: The authors report no conflicts of interest related to this work.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rajneesh Kumar, MBBS, MD, MRCP, Adjunct assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore. rajneeshkrs@gmail.com
Telephone: +65-65767662
Received: March 17, 2019
Peer-review started: March 18, 2019
First decision: May 9, 2019
Revised: May 20, 2019
Accepted: May 22, 2019
Article in press: May 22, 2019
Published online: May 31, 2019
Processing time: 76 Days and 7.2 Hours
Abstract

Hepatitis B viral (HBV) reactivation in the immunosuppressed is a significant problem even in patients who have achieved serological clearance due to the persistence of HBV as cccDNA. HBV reactivation will continue to pose a significant healthcare burden given the high prevalence of HBV and increasing use of immunosuppressants. Screening of hepatitis B surface antigen, antibody to Hepatitis B core antigen antibody and HBV DNA levels should be done routinely in all patients planned for significant immunosuppressant use. We aimed to examine the factors affecting reactivation risk. This depended on HBV disease status, the underlying disease requiring immunosuppression, and the specific immunosuppressive regime. While antiviral prophylaxis can prevent reactivation, it increases cost and still has risk of delayed reactivation after stopping antivirals and close follow-up and on-demand treatment is a good alternative for patients at risk of reactivation.

Keywords: Previous hepatitis B exposure; Immunosuppression; Cost-effectiveness; Hepatitis B reactivation

Core tip: Hepatitis B reactivation remains a common clinical problem, in countries with high endemicity of Hepatitis B, prevalence of Hepatitis B exposure can be very high where hepatitis B virus (HBV) DNA and HbsAg is negative. This group of patients when undergoing chemotherapy or immunusuppresion can have reactivation and HBV DNA can be positive, this review summaries the key studies and guide in rationale approach.