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Korean J Gastroenterol  <  Volume 74(5); 2019 <  Articles

Korean J Gastroenterol 2019; 74(5): 258-266  https://doi.org/10.4166/kjg.2019.74.5.258
Prophylactic Antiviral Treatment in Immunosuppressed Chronic Hepatitis B Patients
Eileen L. Yoon
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Correspondence to: Eileen L. Yoon, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea. Tel: +82-2-950-8824, Fax: +82-2-950-8886, E-mail: mseileen80@gmail.com, ORCID: https://orcid.org/0000-0003-0474-048X
Received: October 18, 2019; Revised: October 18, 2019; Accepted: November 9, 2019; Published online: November 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Improved management of chronic hepatitis B patients with oral nucleos(t)ide analogues has increased the number of these patients who are getting older and have other accompanying comorbidities. These comorbidities frequently require various immunosuppression treatments and/or cytotoxic chemotherapy. Not only the patients who are positive for HBsAg, but also the patients who are positive for isolated anti-HBc are at risk for hepatitis B reactivation during immunosuppression. Prophylactic antiviral treatment with oral nucleos(t)ide analogues with high genetic barriers can decrease the risks of HBV reactivation, HBV reactivation- associated hepatitis, and mortality in these patients. It is crucial to screen HBV markers in all of the patients who have to undergo immunosuppression, be administered prophylactic antiviral treatment in the high risk groups, and be monitored for HBV reactivation during and after immunosuppression and/or cytotoxic chemotherapy. This study summarizes the recommendations from the recently updated guidelines from Korea, United States, and Europe.
Keywords: Hepatitis B, chronic; Immunosuppression; Reactivation; Prophylactic


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