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Inicio Medicina Clínica (English Edition) Reactivation of hepatitis B associated with immunosuppressants and chemotherapy....
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Vol. 152. Issue 3.
Pages 107-114 (February 2019)
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Vol. 152. Issue 3.
Pages 107-114 (February 2019)
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Reactivation of hepatitis B associated with immunosuppressants and chemotherapy. Natural history, risk factors and recommendations for prevention
Reactivación de la hepatitis B asociada a agentes inmunodepresores y a quimioterapia. Historia natural, factores de riesgo y recomendaciones para prevenirla
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Rosa Maria Morillasa,b,
Corresponding author
, David López Sisamónc
a Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
b CIBERehd-Instituto de Salud Carlos III, Spain
c Unidad de Farmacia Oncológica ICO-Badalona, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Table 1. Risk factors for HBV reactivation.
Table 2. Risk of reactivation associated with immunosuppressive treatment in HBsAg positive patients.
Table 3. Risk of reactivation associated with immunosuppressive treatment in HBsAg negative and anti-HBc positive patients.
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Abstract

Although the risk of reactivation of hepatitis B in patients treated with immunosuppressants has been known for years and, if there are recommendations, data from some surveys indicate that the study of the serological profile of HBV infection before starting immunosuppressive treatment is not universal practice. Taking into account the serious consequences that the reactivation of the infection with HBV may entail, we believe that it is necessary to disclose the importance of this problem among the health professionals who prescribe these treatments as well as the recommendations to be followed. In fact, in recent years, the use of chemotherapy and potent immunosuppressants in patients with neoplastic processes and in non-neoplastic pathology of various specialties has been increasingly frequent, increasing the population of patients at risk of reactivation of HBV.

Keywords:
Hepatitis B reactivation
Immunosuppressive and biological modifier therapies
Management strategies
Prophylaxis
Resumen

A pesar de que el riesgo de reactivación de la hepatitis B en los pacientes tratados con inmunosupresores es conocido desde hace años y de la existencia de recomendaciones, los datos procedentes de algunas encuestas indican que el estudio del perfil serológico de la infección por el VHB antes de iniciar el tratamiento inmunosupresor no es una práctica universal. Teniendo en cuenta las consecuencias graves que puede comportar la reactivación de la infección por el VHB, creemos que es necesario divulgar la importancia de este problema entre los profesionales sanitarios que prescriben estos tratamientos así como de las recomendaciones a seguir. De hecho, en los últimos años, es cada vez más frecuente el empleo de quimioterapia e inmunosupresores potentes en pacientes con procesos neoplásicos y en patología no neoplásica de diversas especialidades, aumentando la población de pacientes con riesgo de reactivación del VHB.

Palabras clave:
Reactivación de la hepatitis B
Inmunodepresores y tratamientos biológicos
Estrategias de manejo
Profilaxis

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