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.
Classes of medications other than immunosuppressants may also trigger HBVr. The FDA has issued a warning regarding direct-acting antivirals, but optimal management of these patients is still evolving.
Once HBV status is established, a patient’s risk for HBVr can be specified as high, moderate, or low using their HBV status and the type of therapy being initiated. The AGA recommends prophylactic treatment with well-tolerated and effective agents for patients classified as high or moderate risk. If a patient’s risk is low, regular monitoring of HBV DNA and AST and ALT levels is sufficient. Recommendations of monitoring intervals span from monthly to every 3 months.13,14
CASEGiven the patient’s status of resolved HBV infection and her current moderate-dose regimen of prednisone, her risk for HBV reactivation is moderate. She could either receive antiviral prophylaxis or undergo regular monitoring. Following a discussion of the options, she opts for referral to a hepatologist to discuss possible prophylactic treatment.
Increased awareness of HBVr risk associated with immunosuppressive therapy, coupled with a planned approach to appropriate screening and risk stratification, can help health care providers prevent the reactivation of HBV or initiate early intervention for CHB.
CORRESPONDENCE Ronan Farrell, MD, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903; ronan_farrell@brown.edu.
