Reactivation of Hepatitis B During Immunosuppressive Therapy: Potentially Fatal Yet Preventable
Authors: Anna S.F. Lok, John W. Ward, Robert P. Perrillo, Brian J. McMahon, T. Jake Liang
Journal: Annals of Internal Medicine (2012)

Ideas and Opinions15 May 2012Reactivation of Hepatitis B During Immunosuppressive Therapy: Potentially Fatal Yet PreventableAnna S.F. Lok, MD, John W. Ward, MD, Robert P. Perrillo, MD, Brian J. McMahon, MD, and T. Jake Liang, MDAnna S.F. Lok, MDFrom University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia., John W. Ward, MDFrom University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia., Robert P. Perrillo, MDFrom University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia., Brian J. McMahon, MDFrom University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia., and T. Jake Liang, MDFrom University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-10-201205150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Reactivation of hepatitis B virus (HBV) replication, an abrupt increase or reappearance of serum HBV DNA in a patient with chronic or past HBV infection, is a known complication of immunosuppressive therapy. This condition can lead to hepatocellular injury, elevated alanine aminotransferase levels, symptoms of acute hepatitis, liver failure, and even death (1). Many physicians who regularly prescribe immunosuppressive therapy unfortunately do not recognize this potentially fatal condition.Hepatitis B virus reactivation has been best studied in patients receiving chemotherapy for hematologic cancer, but it has also been reported during treatment of solid tumors (2). In addition, reactivation can occur ...References1. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009;49:S156-65. [PMID: 19399803] CrossrefMedlineGoogle Scholar2. Yeo W, Chan PK, Zhong S, Ho WM, Steinberg JL, Tam JS, et al. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors. J Med Virol. 2000;62:299-307. [PMID: 11055239] CrossrefMedlineGoogle Scholar3. Carroll MB, Forgione MA. 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Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al; American College of Rheumatology. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762-84. [PMID: 18512708] CrossrefMedlineGoogle Scholar18. Stine JG, Khokhar OS, Charalambopoulos J, Shanmugam VK, Lewis JH. Rheumatologists' awareness of and screening practices for hepatitis B virus infection prior to initiating immunomodulatory therapy. Arthritis Care Res (Hoboken). 2010;62:704-11. [PMID: 20461789] CrossrefMedlineGoogle Scholar19. McQuillan GM, Townsend TR, Johannes CB, Dillard T, Molteni RA, Ness PM, et al. Prevention of perinatal transmission of hepatitis B virus: the sensitivity, specificity, and predictive value of the recommended screening questions to detect high-risk women in an obstetric population. Am J Epidemiol. 1987;126:484-91. 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[PMID: 20533878] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Michigan, Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; Baylor Medical Center, Dallas, Texas; Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Programs, Centers for Disease Control and Prevention, Anchorage, Alaska; and American Association for the Study of Liver Diseases, Alexandria, Virginia.Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2603.Corresponding Author: Anna S.F. Lok, MD, Division of Gastroenterology and Hepatology, University of Michigan Health System, 3110G Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected]edu.Current Author Addresses: Dr. Lok: Division of Gastroenterology and Hepatology, University of Michigan Health System, 3110G Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI 48109.Dr. Ward: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Road, Atlanta, GA 30333.Dr. Perrillo: Baylor University Medical Center, Sammons Center Building, 3410 Worth Street, Dallas, TX 75246.Dr. McMahon: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, 4315 Diplomacy Drive, Anchorage, AK 99508.Dr. Liang: American Association for the Study of Liver Diseases, 1001 North Fairfax Street, Suite 400, Alexandria, VA 22314.Author Contributions: Conception and design: A.S.F. Lok, J.W. Ward, R.P. Perrillo, B.J. McMahon, T.J. Liang.Analysis and interpretation of the data: A.S.F. Lok, J.W. Ward, R.P. Perrillo, B.J. McMahon, T.J. Liang.Drafting of the article: A.S.F. Lok, J.W. Ward, R.P. Perrillo.Critical revision of the article for important intellectual content: A.S.F. Lok, J.W. Ward, R.P. Perrillo, B.J. McMahon, T.J. Liang.Final approval of the article: A.S.F. Lok, J.W. Ward, R.P. Perrillo, B.J. McMahon, T.J. Liang.Provision of study materials or patients: R.P. Perrillo.Administrative, technical, or logistic support: A.S.F. Lok.Collection and assembly of data: A.S.F. Lok, R.P. Perrillo, T.J. Liang. 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