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. 2018 Dec;8(4):403-431.
doi: 10.1016/j.jceh.2018.06.010. Epub 2018 Jun 26.

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

Anil Arora  1 , Anil C Anand  2 , Ashish Kumar  1 , Shivaram P Singh  3 , Rakesh Aggarwal  4 , Radha K Dhiman  5 , Shyam Aggarwal  6 , Seema Alam  7 , Pradeep Bhaumik  8 , Vinod K Dixit  9 , Ashish Goel  10 , Bhabadev Goswami  11 , Ashok Kumar  12 , Manoj Kumar  13 , Kaushal Madan  14 , Natarajan Murugan  15 , Aabha Nagral  16 , Amarender S Puri  17 , Padaki N Rao  18 , Neeraj Saraf  19 , Vivek A Saraswat  4 , Sanjeev Sehgal  20 , Praveen Sharma  1 , Koticherry T Shenoy  21 , Manav Wadhawan  22 ; Members of the INASL taskforce on Hepatitis B
Affiliations

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

Anil Arora et al. J Clin Exp Hepatol. 2018 Dec.

Abstract

Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published the first INASL guidelines on management of HBV infection in India. In the present guidelines, which are in continuation with the previous guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids are addressed.

Keywords: ACLF, Acute-on-Chronic Liver Failure; AFP, Alphafetoprotein; ALT, Alanine Aminotransferase; Anti-HBc, Antibodies to Hepatitis B Core Antigen; Anti-HBs, Antibodies to Hepatitis B Surface Antigen; CHB, Chronic Hepatitis B; CHOP, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone; CKD, Chronic Kidney Disease; DILI, Drug-Induced Liver Injury; DNA, Deoxyribonucleic Acid; ETV, Entecavir; GRADE, Grading of Recommendations, Assessment, Development and Evaluation; HAV, Hepatitis A Virus; HBIG, Hepatitis B Immune Globulin; HBV DNA, Hepatitis B Virus Deoxyribonucleic Acid; HBV, Hepatitis B Virus; HBcAg, Hepatitis B Core Antigen; HBeAg, Hepatitis B Envelope Antigen; HBsAg, Hepatitis B Surface Antigen; HDV, Hepatitis D Virus; HEV, Hepatitis E Virus; HLA, Human Leukocyte Antigen Class I; INASL, Indian National Association for Study of the Liver; LAM, Lamivudine; NAs, Nucleos(t)ide Analogs; NHL, Non-Hodgkin’s Lymphoma; NK, Natural Killer; PegIFN-α, Pegylated Interferon Alpha; RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus; TAF, Tenofovir Alafenamide; TDF, Tenofovir Disoproxil Fumarate; TLC, Total Leucocyte Count; ULN, Upper Limit of Normal; cancer; cccDNA, Covalently Closed Circular Deoxyribonucleic Acid; chemotherapy; hepatitis B; immunosupressants; liver failure; rcDNA, Relaxed-Circular Deoxyribonucleic Acid.

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Figures

Figure 1
Figure 1
Life cycle of hepatitis B virus.
Figure 2
Figure 2
Algorithm for screening and prevention of hepatitis B virus (HBV) reactivation in patients being planned for chemotherapy of HSCT for hematologic or non-hematologic malignancy.
Figure 3
Figure 3
Algorithm for screening and prevention of hepatitis B virus (HBV) reactivation in patients being planned for biological therapy.
Figure 4
Figure 4
Algorithm for management of HBV patients undergoing solid organ transplantation.
Figure 5
Figure 5
Algorithm for management of HBV patients receiving corticosteroids.
See this image and copyright information in PMC

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