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Hepatitis B virus (HBV) reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies
  1. L H Calabrese1,
  2. N N Zein2,
  3. D Vassilopoulos3
  1. 1Department of Rheumatic and Immunological Disease, Cleveland Clinic Foundation, Cleveland, USA
  2. 2Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, USA
  3. 3Athens University School of Medicine, Hippokration General Hospital, Athens, Greece
  1. 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}


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.

  • 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
  • hepatitis B virus 
  • biologic therapy
  • immunosuppression

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