RT Journal Article
SR Electronic
T1 Hepatitis B virus reactivation in patients treated with immunosuppressive drugs: a practical guide for clinicians
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 212
OP 218
DO 10.7861/clinmedicine.18-3-212
VO 18
IS 3
A1 Apostolos Koffas
A1 Grace E Dolman
A1 Patrick TF Kennedy
YR 2018
UL http://www.rcpjournals.org/content/18/3/212.abstract
AB Hepatitis B virus reactivation (HBVr) is emerging as an important clinical entity, with the advent of highly potent immunosuppression licensed for use as the treatment of a widening range of clinical indications. HBVr can lead to severe acute liver failure and death. Risk can be minimised through appropriate screening, monitoring and antiviral prophylaxis. Screening for serological markers at the ­earliest opportunity is recommended. Risk stratification should then be performed on the basis of characteristics of the ­underlying disease, markers of viral activity and the potency of proposed immunosuppression. In this review, we summarise the most recent recommendations from the relevant international societies. We also provide suggestions on how a robust multidisciplinary service can be delivered to prevent HBVr in UK clinical practice through optimisation of resources and introduction of checkpoints to prevent the inappropriate administration of immunosuppression to those at significant risk of HBVr.