Need to improve awareness and management of hepatitis B reactivation in patients receiving immunosuppressive therapy

Hepatitis B reactivation in patients receiving immunosuppressive therapy is not an uncommon event because of upsurge in the development of more potent and new immunosuppressive therapy (IST) including monoclonal antibodies leading to profound B cell depletion. However, this condition is still not being commonly made known to practising clinicians. More importantly, serious adverse outcomes including liver decompensation and death have been reported from time to time. This is likely related to the insufficient efforts to disseminate the knowledge or inattentive attitude from clinicians towards the need for hepatitis B virus screening before starting IST. It is of crucial importance, as these adverse outcomes are largely preventable by prophylactic or early treatment by antiviral agents. The risk of hepatitis B reactivation depends on the type and duration of the IST, patient characteristics and disease conditions. While we are eagerly waiting for a more cohesive consensual management recommendations from the different specialties who are involved in managing these patients, consolidated data are readily available for clinicians to define whether their patients would have a low or a high risk of hepatitis B reactivation. A management strategy without ambiguity should be formulated.