Current trends in management of hepatitis B virus reactivation in the biologic therapy era

• 作 者: Claudio M Mastroianni Miriam Lichtner Rita Citton Cosmo Del Borgo Angela Rago Helene Martini Giuseppe Cimino Vincenzo Vullo
• 机 构: Infectious Diseases Unit, Fondazione Eleonora Lorillard Spencer Cenci, Sapienza University, SM Goret
• 出 处: World Journal of Gastroenterology
• 发表日期: 2011年34期
• 关键词: biologic antiviral monoclonal prior consequences mandatory occult HBsAb cytotoxi

Hepatitis B virus (HBV) reactivation represents an emerging cause of liver disease in patients undergoing treatment with biologic agents. In particular, the risk ofHBV reactivation is heightened by the use monoclonalantibodies, such as rituximab (anti-CD20) and alemtuzumab (anti-CD52) that cause profound and longlasting immunosuppression. Emerging data indicatethat HBV reactivation could also develop following theuse of other biologic agents, such as tumor necrosis factor (TNF)-α inhibitors. When HBV reactivation is di-agnosed, it is mandatory to suspend biologic treatmentand start antiviral agents immediately. However, preemptive antiviral therapy prior to monoclonal antibodyadministration is crucial in preventing HBV reactivationand its clinical consequences. Several lines of evidencehave shown that risk of HBV reactivation is greatlyreduced by the identifi cation of high-risk patients andthe use of prophylactic antiviral therapy. In this article, we discuss current trends in the management of HBV reactivation in immunosuppressed patients receiving biologic therapy, such as rituximab, alemtuzumab and TNF-α antagonists.

In particular, the risk of HBV reactivation is heightened by the use of monoclonalantibodies, such as rituximab (anti-CD20) and alemtuzumab (anti-CD52 ) that cause profound and longlasting immunosuppression. Emerging data indicate that HBV reactivation could also develop the same of the other biologic agents, such as tumor necrosis factor (TNF) -α inhibitors. When HBV reactivation is di-agnosed, it is mandatory to suspend biologic treatmentand start antiviral agents immediately. However, preemptive antiviral therapy prior to monoclonal antibody administration is crucial in preventing HBV reactivation and its clinical consequences. Several lines of evidencehave shown that risk of HBV reactivation is greatly reduced by the identification of high-risk patients and the use of prophylactic antiviral therapy. In this article, we discuss current trends in the ma nagement of HBV reactivation in immunosuppressed patients receiving biologic therapy, such as rituximab, alemtuzumab and TNF-α antagonists.