HBV Reactivation (ondemand)-HBV Reactivation

Video Transcription

Video Summary

Robert Gish and Christine Droz present an AASLD Hepatitis B/Delta SIG webinar on hepatitis B (HBV) reactivation during immunosuppressive therapy. They stress universal adult HBV screening with the “triple panel” (HBsAg, anti-HBc, anti-HBs) and clarify test interpretation: anti-HBc indicates prior exposure and reactivation risk; anti-HBs indicates immunity but may not protect during strong B‑cell–depleting therapy; HBsAg indicates infection and warrants HBV DNA testing. They define HBV reactivation (e.g., ≥2‑log HBV DNA rise, new detectable DNA, or HBsAg seroreversion) and hepatitis flare (ALT ≥3× baseline or >100). Reactivation can cause liver failure and interrupt life-saving cancer treatment.<br /><br />They review guideline-based risk stratification (AGA 2025 highlighted): high risk → prophylaxis; moderate risk → prophylaxis preferred but close monitoring is an option; low risk → monitoring with labs and HBV DNA every 1–3 months. Preferred prophylaxis is tenofovir (TAF/TDF) or entecavir, started before immunosuppression and continued at least 6 months after, and 12–18 months after B‑cell–depleting agents. Case examples include rituximab in anti-HBc+ patients (high risk), IL‑17 inhibitor for psoriasis (moderate risk), and HBsAg+ cancer therapy with conflicting risk data—managed with a low threshold to treat.

Keywords

HBV reactivation

immunosuppressive therapy

universal adult HBV screening

HBV triple panel (HBsAg anti-HBc anti-HBs)

risk stratification (AGA 2025)

antiviral prophylaxis (tenofovir entecavir)

B-cell–depleting agents (rituximab)

HBV DNA monitoring (every 1–3 months)

hepatitis flare (ALT elevation)