title: Immunosuppression in Patients with Chronic Hepatitis B.
abstract: After hepatitis B virus (HBV) infection, HBV DNA persists in minute amounts in hepatocyte nuclei even in individuals with "resolved" infection. Viral replication and development of liver disease depend on the balance between viral mechanisms promoting persistence and host immune control. Patients with active or inactive disease or resolved HBV infection are at risk for reactivation with immunosuppressive therapy use. HBV reactivation varies from a clinically asymptomatic condition to one associated with acute liver failure and death. We review recent studies on HBV reactivation during immunomodulatory therapies for oncologic, gastroenterological, rheumatic, and dermatologic disorders. Risk calculation should be determined through HBV screening and assessment of immunosuppressive therapy potency. We also discuss monitoring for reactivation, prophylactic antiviral therapy, and treatment of reactivation. Prophylactic antiviral treatment is needed for all HBsAg carriers and selected patients who have anti-HBc without HBsAg and is critical for preventing viral reactivation and improving outcomes.
authors.affiliation: Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ USA ; University of Arizona College of Medicine, Phoenix, AZ USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Seetharam
authors.affiliation: Hepatology Division, Baylor University Medical Center, Dallas, TX USA ; Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Perrillo
authors.affiliation: St. Joseph's Hospital Medical Center/Liver Center, Phoenix, AZ USA ; 6022 La Jolla Mesa Drive, San Diego, CA 92037 USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gish
keywords: Chemotherapy; Entecavir; HBV DNA; Hepatitis B; Immunosuppression; Lymphoma; Prophylactic therapy; Reactivation; Rituximab
references.citation: Anticancer Res. 2004 Sep-Oct;24(5A):3035-40
references.pmid: 15517913
references.citation: Turk J Gastroenterol. 2010 Jun;21(2):197-8
references.pmid: 20872342
references.citation: Aliment Pharmacol Ther. 2010 Jan 15;31(2):240-6
references.pmid: 19814747
references.citation: Int J Radiat Oncol Biol Phys. 2009 Dec 1;75(5):1545-52
references.pmid: 19327909
references.citation: Expert Rev Anti Infect Ther. 2011 Oct;9(10):891-9
references.pmid: 21973301
references.citation: Gastroenterology. 2001 Mar;120(4):1009-22
references.pmid: 11231956
references.citation: J Clin Oncol. 2009 Feb 1;27(4):605-11
references.pmid: 19075267
references.citation: Hepatology. 2006 Feb;43(2):233-40
references.pmid: 16440357
references.citation: Intern Med. 2012;51(12):1623-6
references.pmid: 22728503
references.citation: Transplantation. 2005 Mar 15;79(5):616-9
references.pmid: 15753855
references.citation: MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
references.pmid: 18802412
references.citation: Eur J Haematol. 2005 Mar;74(3):254-8
references.pmid: 15693796
references.citation: Hepatol Int. 2012 Jun;6(3):531-61
references.pmid: 26201469
references.citation: Arthritis Care Res (Hoboken). 2013 Sep;65(9):1504-14
references.pmid: 23436730
references.citation: Nat Med. 1996 Oct;2(10):1104-8
references.pmid: 8837608
references.citation: Ann Hematol. 2011 Oct;90(10):1219-23
references.pmid: 21520001
references.citation: Ann Intern Med. 1990 Mar 1;112(5):381-2
references.pmid: 2306066
references.citation: J Hepatol. 2009 Dec;51(6):1091-6
references.pmid: 19836097
references.citation: J Clin Virol. 2012 Nov;55(3):233-8
references.pmid: 22921412
references.citation: Proc Natl Acad Sci U S A. 1986 Mar;83(6):1627-31
references.pmid: 3006059
references.citation: J Med Virol. 2003 Aug;70(4):553-61
references.pmid: 12794717
references.citation: Hematol Oncol. 1990 Sep-Oct;8(5):261-70
references.pmid: 1701155
references.citation: Nat Rev Gastroenterol Hepatol. 2014 Apr;11(4):209-19
references.pmid: 24247262
references.citation: Arthritis Care Res (Hoboken). 2010 Jun;62(6):749-54
references.pmid: 20535784
references.citation: Br J Cancer. 2004 Apr 5;90(7):1306-11
references.pmid: 15054446
references.citation: J Clin Oncol. 2010 Jul 1;28(19):3199-202
references.pmid: 20516452
references.citation: J Viral Hepat. 2011 Apr;18(4):e40-51
references.pmid: 21143342
references.citation: Lancet. 2013 Feb 9;381(9865):468-75
references.pmid: 23234725
references.citation: Ann Oncol. 2011 May;22(5):1170-1180
references.pmid: 21115603
references.citation: J Viral Hepat. 2006 Sep;13(9):591-6
references.pmid: 16907845
references.citation: Medicine (Baltimore). 2011 Nov;90(6):359-371
references.pmid: 22033451
references.citation: Blood. 2011 Feb 10;117(6):1792-8
references.pmid: 20959600
references.citation: World J Gastroenterol. 2013 Nov 21;19(43):7515-30
references.pmid: 24282343
references.citation: Ann Intern Med. 2009 Jan 20;150(2):104-10
references.pmid: 19124811
references.citation: Ann Hematol. 2004 Dec;83(12):769-74
references.pmid: 15338194
references.citation: Antivir Ther. 2011;16(7):947-9
references.pmid: 22024509
references.citation: Hepatology. 2014 Jun;59(6):2092-100
references.pmid: 24002804
references.citation: J Gastroenterol. 2011 Jan;46(1):9-16
references.pmid: 20924616
references.citation: Eur J Cancer. 2013 Nov;49(16):3486-96
references.pmid: 23910494
references.citation: Ann Intern Med. 2008 Apr 1;148(7):519-28
references.pmid: 18378948
references.citation: J Gastroenterol Hepatol. 1996 Feb;11(2):143-7
references.pmid: 8672759
references.citation: Hepatol Res. 2011 Jun;41(6):553-63
references.pmid: 21615643
references.citation: J Oncol Pract. 2011 May;7(3):141-7
references.pmid: 21886492
references.citation: J Clin Oncol. 2013 Aug 1;31(22):2765-72
references.pmid: 23775967
references.citation: Curr Opin Gastroenterol. 2013 May;29(3):250-6
references.pmid: 23519135
references.citation: Hepatol Res. 2013 Apr;43(4):339-46
references.pmid: 22882474
references.citation: Clin Exp Nephrol. 2011 Oct;15(5):634-640
references.pmid: 21629993
references.citation: World J Gastroenterol. 2011 Mar 28;17(12):1531-7
references.pmid: 21472116
references.citation: Hepatology. 2003 Jun;37(6):1320-8
references.pmid: 12774010
references.citation: N Engl J Med. 2007 Apr 12;356(15):1591-2
references.pmid: 17429098
references.citation: Int J Rheum Dis. 2013 Oct;16(5):527-31
references.pmid: 24164839
references.citation: J Viral Hepat. 2011 Dec;18(12):877-83
references.pmid: 21054683
references.citation: Curr Opin Gastroenterol. 2013 May;29(3):285-92
references.pmid: 23507917
references.citation: Biol Blood Marrow Transplant. 2009 Sep;15(9):1049-59
references.pmid: 19660717
references.citation: J Med Virol. 2011 Nov;83(11):1909-16
references.pmid: 21915865
references.citation: Hepatology. 2010 Jan;51(1):63-72
references.pmid: 19877170
references.citation: Hepatology. 2009 May;49(5 Suppl):S156-65
references.pmid: 19399803
references.citation: World J Gastroenterol. 2013 Nov 28;19(44):7880-8
references.pmid: 24307782
references.citation: J Med Virol. 2000 Nov;62(3):299-307
references.pmid: 11055239
references.citation: Arthritis Res Ther. 2009;11(6):R179
references.pmid: 19941642
references.citation: Hepatology. 2009 May;49(5):1503-14
references.pmid: 19280622
references.citation: Viruses. 2009 Sep;1(2):91-103
references.pmid: 21994540
references.citation: Semin Hematol. 2010 Apr;47(2):187-98
references.pmid: 20350666
references.citation: Clin Rheumatol. 2014 Apr;33(4):577-86
references.pmid: 24343455
references.citation: Med Oncol. 2009 Dec;26(4):386-92
references.pmid: 19021003
references.citation: Hepatology. 2002 Dec;36(6):1408-15
references.pmid: 12447866
references.citation: Gastroenterology. 2006 Jul;131(1):59-68
references.pmid: 16831590
references.citation: Clin Microbiol Infect. 2014 Oct;20(10):O694-701
references.pmid: 24575948
references.citation: Gastroenterology. 1991 Jan;100(1):182-8
references.pmid: 1983820
references.citation: Liver Int. 2013 Sep;33(8):1203-10
references.pmid: 23522150
references.citation: Expert Opin Biol Ther. 2012 Feb;12(2):193-207
references.pmid: 22188392
references.citation: Clin Liver Dis. 2007 Nov;11(4):727-59, vii-viii
references.pmid: 17981227
references.citation: Transplantation. 2002 Jul 27;74(2):182-8
references.pmid: 12151729
references.citation: Br J Cancer. 2013 May 28;108(10):1931-5
references.pmid: 23652302
references.citation: Br J Cancer. 2011 Feb 15;104(4):559-63
references.pmid: 21285992
references.citation: BMC Infect Dis. 2013 Aug 27;13:394
references.pmid: 23977980
references.citation: Semin Liver Dis. 2013 May;33(2):167-77
references.pmid: 23749673
references.citation: Leuk Lymphoma. 2007 Sep;48(9):1866-8
references.pmid: 17786727
references.citation: J Clin Virol. 2013 Jul;57(3):209-14
references.pmid: 23562041
references.citation: Am J Clin Dermatol. 2011 Apr 1;12(2):113-25
references.pmid: 21348542
references.citation: Liver Int. 2009 Sep;29(8):1171-7
references.pmid: 19602139
references.citation: Hepatogastroenterology. 2007 Apr-May;54(75):889-91
references.pmid: 17591085
references.citation: Int Rev Immunol. 2013 Oct-Dec;32(5-6):544-55
references.pmid: 23886112
references.citation: Hepatology. 1993 Dec;18(6):1313-8
references.pmid: 8244254
references.citation: J Med Virol. 2009 Apr;81(4):619-27
references.pmid: 19235854
references.citation: Transplant Proc. 2013 Apr;45(3):982-5
references.pmid: 23622604
references.citation: Eur J Haematol. 2014 Apr;92(4):360-1
references.pmid: 24329558
references.citation: J Natl Compr Canc Netw. 2012 Nov 1;10(11):1412-45
references.pmid: 23138169
references.citation: Br J Dermatol. 2013 Dec;169(6):1295-303
references.pmid: 23746170
references.citation: J Hepatol. 2012 Jul;57(1):167-85
references.pmid: 22436845
references.citation: Immunol Cell Biol. 2007 Jan;85(1):16-23
references.pmid: 17130898