Hepatitis B reactivation: diagnosis and management
Shang-Chin Huang, Hung-Chih Yang & Jia-Horng Kao
Received 30 Mar 2020, Accepted 22 May 2020, Accepted author version posted online: 23 May 2020, Published online: 16 Jun 2020
Hepatitis B virus (HBV) reactivation can be induced by treatments that attenuate the immunological control over HBV, leading to increased morbidity and mortality. The risk of HBV reactivation is determined by host immunity, viral factors, and the type and dose of treatments. However , the risk of HBV reactivation for a growing number of novel therapies remains uncertain and needs to be carefully examined. Identification of patients at risk and administration of prophylactic antiviral agents are critical to prevent HBV reactivation. Early diagnosis and initiation of antiviral treatment are the keys to avoid devastating outcomes.
Area covered
We summarized the latest evidence and recommendations for risk stratification, early diagnosis, prophylaxis, and management of HBV reactivation.
Expert opinion
Universal screening, adequate prophylaxis, and close monitoring are essential for the prevention of HBV reactivation. Risk stratification of patients at risk with appropriate antiviral prophylaxis can prevent HBV reactivation effectively. Several emerging biomarkers have been proved to help determine the risk precisely. Early detection and timely administration of antiviral agents are crucial for management. Further studies on the precision of risk stratification as well as the optimal duration of prophylaxis and treatment are needed to establish an individualized strategy.
KEYWORDS: HBV reactivation, HBV prophylaxis, predictors, risk stratification, nucleos(t)ide analogues
Additional information
Funding
This paper was funded by National Taiwan University Hospital (grant number 108-S254) and the Ministry of Science and Technology, Executive Yuan, Taiwan (grant number 107-2314-B-002-036-MY3).
Article highlights
The risk of HBV reactivation persists both in patients with chronic and resolved infection because the covalently closed circular DNA (cccDNA) of HBV exists in the hepatocytes permanently.
The diagnosis of HBV reactivation is made according to reverse seroconversion of HBsAg, or a significant rise in serum HBV DNA.
The risk of HBV reactivation is determined by host immunity and viral factors as well as type and duration of causative therapies. Those who are anticipated to receive the drugs with risk should be screened routinely.
Antiviral prophylaxis is recommended for patients at high risk (>10%) and may be considered for those at moderate risk (1 – 10%) for HBV reactivation. Those with low risk (<1%) should be monitored closely with blood tests every 1 to 3 months.
For patients not receiving antiviral prophylaxis, early diagnosis of HBV reactivation and timely use of antiviral agents are the key for a better prognosis. The preferred ones for antiviral prophylaxis and treatment are ETV, TDF and TAF.
Future studies will focus on individualized preventive strategies composed of precise risk stratification, the optimal timing of initiation and duration of antiviral therapy.作者: StephenW 时间: 2020-6-18 09:03