Preventing hepatitis B reactivation in immunosuppressed patients: is it time to revisit the guidelines?
Preventing hepatitis B reactivation in immunosuppressed patients: is it time to revisit the guidelines?
复制标题
预防免疫抑制患者乙型肝炎再激活：是时候重新审视指南了吗？
DOI：
10.1002/acr.20167
复制
发表时间：
2010
影响因子：
4.7
通讯作者：
Calabrese,Leonard
中科院分区：
文献类型：
--
作者：
Yazdany,Jinoos;Calabrese,Leonard
乙型肝炎病毒（HBV）感染仍然是一个严重的全球卫生问题。世界上大约三分之一的人口有证据表明以前感染过乙肝病毒，3.5亿人是慢性乙肝病毒携带者。1在美国，自1991年实施消除HBV感染的国家战略以来，新发HBV感染率下降了约82%。下降幅度最大的是1991年以后出生的儿童，1991年首次建议普遍接种儿童疫苗。尽管有这些改善，HBV在美国仍然很流行；估计有80万到140万人是慢性携带者。虽然静脉注射吸毒者和男同性恋者是慢性乙型肝炎病毒的高危人群，但美国的大多数病例是来自高流行地区（如亚洲或非洲）的移民，这些地区的早期水平和垂直传播很常见。在几十年的文献中，免疫抑制个体中HBV的再激活已经得到了充分的记录。再激活可能发生在免疫重建时停止治疗时，也可能发生在长期免疫抑制时，这可能导致HBV感染进程加速。4-6大多数病例发生在接受化疗的癌症患者中，在HBV阳性患者中再激活是常见的（例如在某些淋巴瘤系列中bbb50 %），有时是致命的。7-18在风湿病学中，尽管缺乏大型研究使得很难确定大多数药物的确切风险，但许多疾病修饰抗风湿药（DMARDs）已报道HBV再激活。然而，越来越明显的是，新的生物疗法，如TNF-α抑制剂和利妥昔单抗，可能会造成HBV再激活的重大风险。因此，在临床实践中评估风湿病学家如何处理HBV是特别及时的。
Hepatitis B virus (HBV) infection remains a serious global health concern. Approximately one third of the world's population has evidence of previous HBV infection, and 350 million people are chronic HBV carriers. 1 In the United States, the rate of new HBV infections has declined by approximately 82% since 1991, when a national strategy to eliminate HBV infection was implemented. 2 The greatest decline has been among those born since 1991, when universal vaccination of children was first recommended. 2 Despite these improvements, HBV remains prevalent in the United States; 800,000 to 1.4 million individuals are estimated to be chronic carriers. 2 Although intravenous drug users and homosexual men are at high risk for chronic HBV, most cases in the United States are in those emigrating from high prevalence areas (eg Asia or Africa), where early life horizontal and vertical transmission is common. 3Reactivation of HBV in immunosuppressed individuals has been well-documented in the literature for several decades. Reactivation can occur either at the cessation of therapy when immune reconstitution occurs, or with prolonged immunosuppression that can result in an accelerated course of HBV infection. 4-6 Most cases occur in individuals with cancer undergoing chemotherapy, where reactivation among HBV positive patients is common (eg> 50% in some lymphoma series) and sometimes fatal. 7-18 In rheumatology, HBV reactivation has been reported with a number of disease modifying anti-rheumatic drugs (DMARDs), although the lack of large studies makes it hard to ascertain the exact risk for most drugs. However, it is increasingly apparent that newer biologic therapies, such as TNF-α inhibitors and rituximab, may pose a significant risk of HBV reactivation. Therefore, it is especially timely to take stock of how rheumatologists approach HBV in clinical practice.