REVIEW

Hepatitis B virus (HBV) reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies

L H Calabrese¹, N N Zein², D Vassilopoulos³

¹ Department of Rheumatic and Immunological Disease, Cleveland Clinic Foundation, Cleveland, USA
² Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, USA
³ Athens University School of Medicine, Hippokration General Hospital, Athens, Greece

Correspondence to:
Dr L H Calabrese
DO, Department of Rheumatic and Immunological Disease, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA; calabrl{at}ccf.org

Understanding of the natural history and basic biology of hepatitis B virus (HBV) has increased greatly in recent years. In view of this, the following are reviewed here: (a) recent advances in HBV biology pertinent to the rheumatic disease population; (b) the risks of HBV reactivation in patients with rheumatic disease undergoing immunosuppression; and (c) potential strategies to manage these risks.

Abbreviations: ALT, alanine aminotransferase; anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface antigen; HBcAg, hepatitis B core antigen; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; HHBV, hepatitis B virus; HCC, hepatocellular carcinoma; IFN, interferon; TNF, tumour necrosis factor

Keywords: hepatitis B virus; biologic therapy; immunosuppression

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