title: Reactivation of hepatitis B virus during targeted therapies for cancer and immune-mediated disorders.
abstract: Targeted therapies have gained popularity in the treatment of several oncologic and immune-mediated diseases. Immunosuppression caused by these drugs has been associated to reactivation of hepatitis B virus (HBV) in both hepatitis B surface antigen (HBsAg) positive patients (overt infection) and HBsAg negative/anti-hepatitis B core antigen (anti-HBc) positive carriers (resolved infection), leading to premature discontinuation of therapy and potentially fatal hepatitis.
  
  
  
  This review summarizes the evidence of HBV reactivation in patients with overt or resolved HBV infection undergoing targeted therapies for cancer or immune-mediated disorders, providing recommendations for the management of these patients.
  
  
  
  The risk of HBV reactivation relies on the immunosuppressive potency and duration of these therapies, the underlying disease and the virological patient's profile. However, HBV reactivation is preventable by screening for HBV markers in all patients scheduled to receive targeted therapies, assessing the virological profile and patient's clinical state, followed by appropriate antiviral treatment or prophylaxis in those patients at high risk of HBV reactivation. Close monitoring of HBV carriers at low risk of reactivation is warranted with the aim to start antiviral therapy as soon as HBV reactivates.
authors.affiliation: a Hepatology Unit, Ospedale San Giuseppe , Università di Milano , Milan , Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.affiliation: b Internal Medicine , Ospedale di Desio , Desio , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Serra
authors.affiliation: b Internal Medicine , Ospedale di Desio , Desio , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.affiliation: c A.M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milan , Italy.
authors.forename: Glenda
authors.initials: G
authors.lastname: Grossi
authors.affiliation: c A.M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milan , Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods*; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D006514:Hepatitis B Surface Antigens / Q000276:immunology / Q000378:metabolism; D006515:Hepatitis B virus / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D007154:Immune System Diseases / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D014775:Virus Activation / Q000187:drug effects* / Q000502:physiology
chemical_list: D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents
keywords: Anti-TNF-α; antiviral therapy; biological therapy; cancer; hepatitis B reactivation; monoclonal antibodies; rituximab; targeted therapy