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Hepatitis B Virus Reactivation: Risk Factors and Current Management Strategies.

Authors
  • Smalls, Danielle J1
  • Kiger, Reagan E1
  • Norris, LeAnn B1, 2
  • Bennett, Charles L1, 2, 3, 4, 5
  • Love, Bryan L1, 2, 3
  • 1 Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina.
  • 2 South Carolina Center of Economic Excellence for Medication Safety, University of South Carolina College of Pharmacy, Columbia, South Carolina.
  • 3 William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina.
  • 4 Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
  • 5 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Dec 01, 2019
Volume
39
Issue
12
Pages
1190–1203
Identifiers
DOI: 10.1002/phar.2340
PMID: 31596963
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Hepatitis B virus (HBV) is a global disease with significant morbidity and mortality. Worldwide, ~257 million people are chronically infected with HBV, defined as having a positive hepatitis B surface antigen, but millions more have prior HBV exposure indicated by positive hepatitis B core antibody. Reactivation of hepatitis B implies a sudden increase in viral replication in a patient with chronic HBV infection or prior HBV exposure. Hepatitis B virus reactivation (HBVr) can occur spontaneously, but it is more commonly triggered by immunosuppressive therapies for cancer, immunologic diseases, or transplantation. Elimination of hepatitis C virus (HCV) in HBV-HCV coinfected individuals treated with direct-acting antivirals (DAAs) has also been identified as an important cause of HBVr. Hepatitis B virus reactivation is an underappreciated but important complication of common medical therapies that can delay treatment or result in clinical episodes of hepatitis, hepatic failure, or death. In this review, factors associated with HBVr, particularly medication-related risks, are explored. We review data involving rituximab and ofatumumab, doxorubicin, corticosteroids, tumor necrosis factor antagonists, tyrosine kinases, bortezomib, hematologic stem cell transplantation, and DAAs for HCV treatment. In addition, we discuss screening strategies, choice of antiviral prophylaxis, and the optimal duration of therapy for HBVr. With additional awareness, screening, and appropriate antiviral therapy, it is expected that most cases of HBVr can be prevented. © 2019 Pharmacotherapy Publications, Inc.

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