Prophylaxis and treatment of hepatitis B in immunocompromised patients

Abstract 

The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and referred mainly to the pre-antivirals era. Today a rational approach to the problem of hepatitis B in these patients provides for: (a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), (b) the treatment with antivirals (therapy) of active carriers, (c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, (d) the biochemical and hepatitis B surface antigen (HBsAg) monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous contact with HBV (HBsAg negative and anti-HBc positive), in order to prevent reverse seroconversion.

Moreover it is suggested a strict adherence to criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants and in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg positive candidates and in HBsAg negative recipients of anti-HBc positive grafts.

Abbreviations: ABVD, Doxorubicine, Bleomycin, Vinblastine, Dacarbazine (standard therapy for Hodgkin lymphoma), anti-core, an HBsAg negative/anti-HBc positive subject, anti-HBc, antibody to hepatitis B core antigen, anti-HBe, antibody to hepatitis e antigen, anti-HBs, antibody to HBsAg, ART, anti-retroviral therapy, CHOP, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone, D, donor, GvHD, Graft versus Host Disease, HAI, histology activity index, HBeAg, hepatitis B envelope antigen, HBIG, anti-HBV specific immunoglobulins, HBsAg, hepatitis B surface antigen, HBV, hepatitis B virus, HCV, hepatitis C virus, HDV, hepatitis D virus, HIV, human immunodeficiency virus, HSCT, haematopoietic stem cells transplantation, IFN, interferon, INR, international normal ratio, MOF, multi organ failure, NAs, nucleos(t)ides analogues, PCR, polymerase chain reaction, PNLG, Piano Nazionale Linee Guida (National Guidelines), R, recipient, RCTs, randomized controlled trials, T, therapy, TNF, tumor necrosis factor, TP, targeted prophylaxis, UP, universal prophylaxis, US, ultrasound, VOD, veno-occlusive disease, YMDD, lamivudine-resistant mutants in locus YMDD of the polymerase gene

Keywords: Antivirals, HBV, Immunosuppression, Transplants