Hepatitis B Reactivation: The Challenges of a New Class of Immunosuppressants and Immunomodulators

Hepatitis B Reactivation: The Challenges of a New Class of Immunosuppressants and Immunomodulators

• In a patient with HBsAg+ - NA prophylaxis is the best approach as most new drugs present a high risk of HBV reactivation.
• In patients with HBsAg-/anti-HB, monitoring with on-demand use of NA can be used for most drug classes.
• For patients receiving immune modulators (IM) or chemotherapy, antiviral therapy should start at the same time or 1 week before the IM drug. Entecavir, TAF or TDF is preferred due to the high resistance to the barrier. For patients on long-term immunosuppressive therapy, HBV prophylaxis should be continued indefinitely.
• Antiviral therapy should be continued for 6 months after the last dose of the IM drug. Lastly, remember screening for HBsAg/anti-HBc is the key to managing the risk of HBV reactivation.