乙型肝炎病毒再激活:危险因素和当前管理策略

D. Smalls, Reagan E Kiger, L. Norris, C. Bennett, B. Love
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引用次数: 39

摘要

乙型肝炎病毒(HBV)是一种发病率和死亡率很高的全球性疾病。在世界范围内,约有2.57亿人慢性感染HBV,定义为乙型肝炎表面抗原阳性,但还有数百万人有乙型肝炎核心抗体阳性的HBV暴露史。乙型肝炎再激活意味着慢性HBV感染或既往HBV暴露患者的病毒复制突然增加。乙型肝炎病毒再激活(HBVr)可以自发发生,但更常见的是由癌症、免疫疾病或移植的免疫抑制治疗引发的。在接受直接作用抗病毒药物(DAAs)治疗的HBV - HCV共感染者中,丙型肝炎病毒(HCV)的消除也被确定为HBVr的一个重要原因。乙型肝炎病毒再激活是一种未被重视但重要的常见药物治疗并发症,可延迟治疗或导致肝炎、肝功能衰竭或死亡的临床发作。在这篇综述中,探讨了与HBVr相关的因素,特别是与药物相关的风险。我们回顾了有关利妥昔单抗和ofatumumab、阿霉素、皮质类固醇、肿瘤坏死因子拮抗剂、酪氨酸激酶、硼替佐米、血液干细胞移植和daa治疗HCV的数据。此外,我们还讨论了筛查策略、抗病毒预防药物的选择以及HBVr的最佳治疗时间。有了更多的认识、筛查和适当的抗病毒治疗,预计大多数HBVr病例是可以预防的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hepatitis B Virus Reactivation: Risk Factors and Current Management Strategies
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.
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