Evaluation of hepatitis B virus reactivation prevention measures in immunosuppressed patients: current status and effectiveness.

IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY
Translational gastroenterology and hepatology Pub Date : 2025-01-09 eCollection Date: 2025-01-01 DOI:10.21037/tgh-24-103
Toru Ishikawa, Mitsuyuki Suzuki, Terasu Honma, Toshiaki Yoshida
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Abstract

Background: Prevention of hepatitis B virus (HBV) reactivation is a very important issue, but there is still no clear strategy. This study aimd to develop and evaluate an in-hospital collaboration flow to prevent HBV reactivation, guided by the Japanese Society of Hepatology (JSH) guidelines.

Methods: We have strengthened and implemented a screening system and for HBV reactivation from February 2022 to January 2023. We assessed the administration of nucleic acid analogs (NAs) in hepatitis B surface antigen (HBsAg) or HBV DNA-positive cases, the detection rate of HBs or hepatitis B core (HBc) antibodies in HBsAg or HBV DNA-negative cases, and the follow-up status of HBV DNA testing. A total of 1,195 patients were included, with exclusions based on the judgement of no need for testing by the attending physician.

Results: Among 1,172 tested patients, 1.88% (n=22) were HBsAg or HBV DNA-positive, all of whom received NA therapy. Among 1,150 HBsAg or HBV DNA-negative cases, 9.91% (n=114) were HBs or HBc antibody-positive, with 82.5% (n=94) undergoing HBV DNA testing. Over the years, the HBV DNA measurement rates increased significantly to 82.5% in 2022.

Conclusions: The implemented screening regimen resulted in high and improving testing rates over time. Most HBsAg or HBV DNA-positive cases were treated with tenofovir alafenamide (TAF), highlighting its potential benefits in terms of safety and adherence. Continued validation and adaptation of the screening system are necessary to further prevent HBV reactivation.

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免疫抑制患者预防乙型肝炎病毒再激活措施的评价:现状和效果。
背景:预防乙型肝炎病毒(HBV)再活化是一个非常重要的问题,但目前仍没有明确的策略。在日本肝病学会(JSH)指南的指导下,本研究旨在开发和评估一种预防HBV再激活的院内协作流程。方法:从2022年2月到2023年1月,我们加强并实施了HBV再激活筛查系统。我们评估了乙型肝炎表面抗原(HBsAg)或HBV DNA阳性病例中核酸类似物(NAs)的给药情况,HBsAg或HBV DNA阴性病例中HBV或乙型肝炎核心(HBc)抗体的检出率,以及HBV DNA检测的随访情况。共有1195名患者被纳入,根据主治医生不需要检测的判断排除。结果:1172例患者中,1.88% (n=22)为HBsAg或HBV dna阳性,均接受NA治疗。在1150例HBsAg或HBV DNA阴性病例中,9.91% (n=114)为HBs或HBc抗体阳性,其中82.5% (n=94)为HBV DNA检测。多年来,HBV DNA检测率显著上升,到2022年达到82.5%。结论:随着时间的推移,实施的筛查方案导致了高且不断改善的检测率。大多数HBsAg或HBV dna阳性病例使用替诺福韦阿拉芬胺(TAF)治疗,突出了其在安全性和依从性方面的潜在益处。继续验证和适应筛选系统是必要的,以进一步防止HBV再激活。
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