Division of Gastroenterology and Hepatology, Brown University, Providence, RI (Dr. Farrell); Division of Gastroenterology and Hepatology, Lankenau Hospital, Main Line Health System, Wynnewodd, Pa (Dr. Leroy); Division of Gastroenterology, University of Pennsylvania, Philadelphia (Dr. Nunes). ronan_farrell@brown.edu
The authors reported no potential conflict of interest relevant to this article.
Prophylactic treatment options are safe and well tolerated. For this reason, committing a high- or moderate-risk patient to a course of treatment should be less of a concern than the risk for HBVr.
A recent meta-analysis demonstrated that tenofovir and entecavir are preferable to lamivudine in preventing HBVr.
In the early randomized controlled trials for HBVr prophylaxis, lamivudine, although effective, unfortunately led to a high incidence of viral resistance after prolonged use, thus diminishing its desirability.18 Newer agents, such as entecavir and tenofovir, have proven just as effective as lamivudine and are largely unaffected by viral resistance.27
In retrospective and prospective studies on HBVr prophylaxis, patients treated with entecavir had less HBV-related hepatitis, less delay in chemotherapy, and a lower rate of HBVr when compared with lamivudine.28,29 Tenofovir is recommended, however, if patients were previously treated with lamivudine.30
A recent meta-analysis demonstrated that tenofovir and entecavir are preferable to lamivudine in preventing HBVr.31
Looking ahead
Screening for HBsAg and anti-HBc total before starting immunosuppressive therapy can reduce morbidity and mortality in patients undergoing such treatment. The AGA recommends screening all patients about to begin high- or moderate-risk therapy or patients in populations with a prevalence of CHB ≥2%, per the CDC.6,21
