Hepatitis B Reactivation: The Controversies Continue
Hepatitis B Reactivation: The Controversies Continue
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DOI：
10.1159/000456587
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发表时间：
2017-01-01
影响因子：
2.3
通讯作者：
Feld, Jordan J.
中科院分区：
文献类型：
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作者：
Feld, Jordan J.
乙型肝炎病毒（HBV）再激活是免疫抑制治疗的一个严重但在很大程度上可以避免的并发症。再激活的后果范围从HBV DNA的亚临床增加到暴发性肝衰竭，这可以通过适当使用预防性抗病毒治疗来预防。然而，哪些患者需要筛查，以及是否所有血清学检测呈阳性的患者都需要抗病毒治疗，这些问题仍然不清楚。其他问题，如抗病毒药物的选择和治疗的持续时间也需要澄清。一些混淆来自于文献中使用不同的定义来定义结果。在这篇综述中，讨论了从重新激活的定义到在不同临床环境中对乙型肝炎表面抗原和单独抗核心抗体阳性患者的管理等争议领域。本文还讨论了最近认识到的丙型肝炎抗病毒治疗背景下的再激活问题，以及对未来研究领域的一些建议，以帮助阐明最佳实践。(C) 2017 S. Karger AG，巴塞尔
Hepatitis B virus (HBV) reactivation is a serious but largely avoidable complication of immunosuppressive therapy. The consequences of reactivation range from subclinical increases in HBV DNA to fulminant liver failure, which can be prevented with the appropriate use of prophylactic antiviral therapy. However, which patients need to be screened and whether all patients who test positive for any serological test require antiviral therapy are issues that still remain unclear. Additional issues such as the choice of antiviral and the duration of treatment also need clarification. Some of the confusion comes from the use of varying definitions in the literature to define outcomes. In this review, areas of controversy from definitions of reactivation to management of patients who are hepatitis B surface antigen and lone anti-core antibody positive in different clinical settings are discussed. The recently recognized issue of reactivation in the setting of hepatitis C antiviral therapy is also addressed as well as some recommendations for areas of future research to help clarify best practices. (C) 2017 S. Karger AG, Basel