title: [Reactivation of Hepatitis B Virus and Guidelines for Its Prevention].
abstract: Since the discovery of hepatitis B virus (HBV) as Australia antigen by Dr. Baruch Blumberg in 1964, significant advances have been made in understanding the pathophysiology of HBV infection, and in developing therapy for infected patients. Today, the progression of chronic hepatitis B to cirrhosis or hepatocellular carcinoma can be prevented using nucleic acid analogs. HBV is thought to be eliminated from patients with acute hepatitis B after they are cured. However, a 1996 study showed that cured hepatitis B patients were positive for HBV DNA and the HBV-specific cytotoxic T-cell response approximately 5 years after acute infection. These results indicate that HBV persists in the livers of patients who have been cured of acute HBV infection. HBV can be activated in chronic hepatitis B patients following steroid treatment. Recent clinical reports described cases of malignant lymphoma with fulminant hepatitis B arising during or after immunosuppressive regimens, such as R-CHOP therapy. Prior to immunosuppressive treatment, such patients are negative for HBs antigen and/or positive for HBs antibody, indicative of previous HBV infection. Sixteen cases of fulminant hepatitis B due to HBV reactivation in previously HBV-infected patients were collected between 2004 and 2009, and all of them had fatal prognoses despite treatment with nucleic acid analogs. Hence, guidelines for the prevention of HBV reactivation in immunosuppressive therapy were originally formulated by the Intractable Hepatobiliary Disease Study Group in 2009, and recently updated by the Japanese Society of Hepatology in 2013. The usefulness of these guidelines has been confirmed by several research groups. Dissemination and further improvement of the guidelines are necessary to prevent HBV reactivation in various types of patient receiving immunosuppressive or anti-cancer treatments.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Tsubouchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014775:Virus Activation
chemical_list: D007166:Immunosuppressive Agents