Management of patients with hepatitis B who require immunosuppressive therapy

被引:181
作者
Hwang, Jessica P. [1 ]
Lok, Anna S-F [2 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Div Internal Med, Dept Gen Internal Med, Houston, TX 77030 USA
[2] Univ Michigan, Dept Internal Med & Gastroenterol, A Alfred Taubman Hlth Care Ctr, Ann Arbor, MI 48109 USA
关键词
VIRUS HBV REACTIVATION; TENOFOVIR DISOPROXIL FUMARATE; STEM-CELL TRANSPLANTATION; PREEMPTIVE LAMIVUDINE THERAPY; CYTOTOXIC CHEMOTHERAPY; CANCER-PATIENTS; HEPATOCELLULAR-CARCINOMA; KIDNEY-TRANSPLANTATION; SURFACE-ANTIGEN; RISK-FACTORS;
D O I
10.1038/nrgastro.2013.216
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Patients with chronic HBV infection are at risk of reactivation of HBV should they require immunosuppressive therapies for a variety of clinical settings, including chemotherapy for patients with cancer, immunosuppression for solid organ and stem cell transplant recipients, and use of anti-CD20 antibodies, TNF inhibitors, or corticosteroids in patients with oncological, gastrointestinal, rheumatological or dermatological conditions. The key to preventing HBV reactivation is the identification of patients with HBV infection prior to immunosuppressive therapy, initiation of prophylactic antiviral therapy in patients at moderate or high risk of HBV reactivation, and close monitoring of other patients so that antiviral therapy can be initiated at the first sign of HBV reactivation. Unfortunately, many patients infected with HBV are unaware of their infection or risk factors, and physicians often do not have sufficient time to systematically assess patients for risk factors for HBV prior to starting immunosuppressive therapy. In this article, we review the incidence, risk factors and outcomes of HBV reactivation, and the efficacy of antiviral therapy in preventing its occurrence. We also propose an algorithm for managing patients with HBV infection who require immunosuppressive therapy.
引用
收藏
页码:209 / 219
页数:11
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