摘要
Currently immunosuppressive and biological agentsare used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus(HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary.
Currently immunosuppressive and biological agentsare used in a more extensive and earlier way inpatients with inflammatory bowel disease, rheumaticor dermatologic diseases. Although these drugs haveshown a significant clinical benefit, the safety of thesetreatments is a challenge. Hepatitis B virus （HBV）reactivations have been reported widely, even includingliver failure and death, and it represents a deep concernin these patients. Current guidelines recommend to preemptivetherapy in patients with immunosuppressantsin general, but preventive measures focused in patientswith corticosteroids and inflammatory diseases arescarce. Screening for HBV infection should be done atdiagnosis. The patients who test positive for hepatitisB surface antigen, but do not meet criteria for antiviraltreatment must receive prophylaxis before undergoingimmunosuppression, including corticosteroids at higherdoses than prednisone 20 mg/d during more than twoweeks. Tenofovir and entecavir are preferred thanlamivudine because of their better resistance profile inlong-term immunosuppressant treatments. There is nota strong evidence, to make a general recommendationon the necessity of prophylaxis therapy in patientswith inflammatory diseases that are taking low dosesof corticosteroids in short term basis or low systemicbioavailability corticosteroids such as budesonide orbeclomethasone dipropionate. In these cases regularlyHBV DNA monitoring is recommended, starting earlyantiviral therapy if DNA levels begin to rise. In patientswith occult or resolved hepatitis the risk of reactivationis much lower, and excepting for Rituximab treatment,the prophylaxis is not necessary.
