A PRACTICAL ALGORITHM FOR NON-HEPATOLOGISTS TO PREVENT HEPATITIS B REACTIVATION RELATED TO IMMUNOSUPPRESSIVE TREATMENT AND CHEMOTHERAPY

Celal Ulasoglu

Department of Gastroenterology, Okan University Medical Faculty, Istanbul, Turkey

Objective: This review aims to raise the awareness and importance of HBV reactivation (HBVr) related to immunosuppressive treatment and chemotherapy. Besides a useful quick algorithm and recommendations for adequate viral serology, avoidance of unnecessary serological testing is also targeted. 

Introduction: During and after immunosuppressive treatment and chemotherapy, hepatitic exacerbations of various degrees of severity and even death can occur in patients who have previously been exposed to hepatitis B virus. In parallel, with the increase in the prevalence of autoimmune diseases and malignancies requiring IST, the variety of numerous biopharmaceutical and chemotherapeutic drugs is also multiplying. However, due to immunosuppression by these drugs, "de novo", latent, or resolved infections such as tuberculosis, listeriosis, pneumocystis jirovecii, histoplasma capsulatum, candidiasis, aspergillosis, herpes, cytomegalovirus, hepatitis B, and hepatitis C can reactivate. 

Materials and methods: The literature regarding the HBVr during and after the immunosuppressive treatment and chemotherapy were analysed and a pathway in clinical practice was formed.

Results: HBsAg, antiHBc, antiHBs, Anti HCV and Anti HIV testing should be done for all candidates of immunosuppressive treatment or chemotherapy prior. 

Conclusion: A practical algorithm for physicians of all specialties for preventive measures to avoid HBV reactivation in patients receiving immunosuppressive treatment and chemotherapy who had previous exposure to hepatitis B virus is presented.