Journal Club

The Risk of Hepatitis B Reactivation With Various Immunosuppressants: A Quick Visual Guide

By Erica Kaufman West, MD

Infectious diseases (ID) physicians are often asked to weigh in on various immunologic questions. One of the most common is the risk of reactivation of various infections when patients are immunosuppressed. This question arises with viral, fungal, and mycobacterial reactivation in transplant patients, patients on biologics, and patients with inherent immunodeficiencies, among other situations.

A recent publication in the Journal of Hepatology looked at hepatitis B virus (HBV) reactivation with different immunosuppressants and immunomodulators, including the newer classes of these agents.  The authors also differentiated between patients who are HBV surface antigen positive and patients who are core antibody-only.

This review serves as a great resource for ID physicians reviewing the mechanisms of these immunomodulating agents and interpreting the HBV reactivation risk. A color-coded chart included in the review (see below) serves as a quick visual as we collaborate with colleagues to care for these complex patients.

(Papatheodoridis et al. J Hepatol. 2022;77(6):1670-1689.)

Figure reprinted from the Journal of Hepatology, volume 77, issue 6, “Hepatitis B virus reactivation associated with new classes of immunosuppressants and immunomodulators: A systematic review, meta-analysis, and expert opinion,” George V. Papatheodoridis, Vasileios Lekakis, Thodoris Voulgaris, Pietro Lampertico, Thomas Berg, Henry L.Y. Chan, Jia-Horng Kao, Norah Terrault, Anna S. Lok, and K. Rajender Reddy, pages 1670-1689, copyright 2022, with permission from Elsevier.