Introduction and Definitions. Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. Chronic HBV carriers are patients who are hepatitis B surface antigen (HBsAg)-seropositive. In uncertain cases of acute hepatitis B vs. severe reactivation of CHB, one should manage these patients as severe reactivation and hepatitis B surface antigen should be retested after 6 months. Patients with hepatitis B (HBV) including chronic inactive HBV or previous HBV infection are at risk of HBV reactivation during use of immunosuppressive therapies for diseases such as cancer, rheumatoid arthritis, multiple sclerosis, etc.Occurrence of significantly rising HBV DNA and rising ALT. 2009 Feb 1;27(4):605-11. doi: 10.1200/JCO.2008.18.0182. Epub 2005 Sep 22.Clin Gastroenterol Hepatol. Reactivation can be transient and clinically silent, but often causes a flare of disease that can be severe resulting in acute hepatic failure. Liver Int. Occurrence of significantly rising HBV DNA and rising ALT. Wiley Clipboard, Search History, and several other advanced features are temporarily unavailable. Step 3: viral genomes are converted to cccDNA molecules. 2009 Feb;134(6):255-8. doi: 10.1055/s-0028-1123989. Viral capsids assemble, incorporating genomic viral RNA, which is reverse transcribed back into a viral DNA genome. For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Conclusions. 2011 Jan;31 Suppl 1:104-10. doi: 10.1111/j.1478-3231.2010.02396.x.Yeo W, Chan TC, Leung NW, Lam WY, Mo FK, Chu MT, Chan HL, Hui EP, Lei KI, Mok TS, Chan PK.J Clin Oncol. [])) Therefore, causes of ALT elevation other than HBV reactivation were excluded. Since this topic was last covered in the March 2015 issue of The definition of HBV reactivation varies between guidelines, but the general concept is similar. Step 6: cytoplasmic mRNA is translated to produce the viral surface, core, polymerase, and X proteins. Epub 2009 Jan 29.Clin Infect Dis. 1. HBV Reactivation: A Hidden Menace With Global Implications. To access the menus on this page please perform the following steps. Hit enter to expand a main menu option (Health, Benefits, etc). Step 2: nucleocapsids (yellow hexagons) are then uncoated in the cytoplasm, releasing the partially double‐stranded viral genomes (single red circles) that are imported into the nucleus. Hepatitis B virus (HBV) reactivation following anticancer drugs, immunosuppressants, or other chemotherapies is a major clinical problem, irrespective of past infection. Slight differences aside, the overarching principles hold (Fig. HBV screening was defined by an HBsAg blood test within 6 months of initiation of chemotherapy. HBV reactivation generally occurs in overt or occult HBV infection patients who suffered DDAs, chemotherapy, or immunosuppressive therapy, especially when some solid tumors and leukemia patients are using hormones such as prednisolone and imatinib. Several randomized, placebo-controlled trials have shown that reactivation can be prevented by antiviral prophylaxis. Reactivation of hepatitis B in the context of immunosuppressive therapy may be severe and potentially fatal. Unable to load your collection due to an error For patients with CHB, antiviral PPX should be started before and continued well after cessation of immunosuppression, generally 12 to 18 months if high‐potency therapies are used and 6 to 12 months for other agents.Guidelines generally agree that resolved HBV patients on high‐potency immunosuppression should be treated similarly to immunosuppressed patients with CHB, with PPX starting before immunosuppression, continued PPX 12 to 18 months after cessation, and monitoring for 12 months after antiviral withdrawal.As for choice of antivirals, the majority of guidelines recommend the nucleoside inhibitors tenofovir and entecavir (ETV) as first‐line therapy for both PPX and treatment, citing several meta‐analyses demonstrating higher efficacy and barriers to resistance compared with lamivudine.HBV reactivation is a serious condition associated with significant morbidity and mortality. 2020 Aug;8(2):e001072. Similar to patients coinfected with HBV and HCV treated with interferon (IFN)‐based therapy, hepatitis due to HBV reactivation in chronic hepatitis C (CHC) patients coinfected with HBV has also been reported after treatment with pan‐oral direct‐acting antiviral agents (DAAs). Step 7: the resulting nucleocapsid cores can either enter the endoplasmic reticulum to be exported from the cell (step 7a) or recycle their genomes into the nucleus to replenish the reservoir of cccDNA (step 7b). Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420If you are in crisis or having thoughts of suicide,