Last updated March 14, 2022

Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy

Recommendations

The AGA recommends antiviral prophylaxis over no prophylaxis for patients at high risk undergoing immunosuppressive drug therapy. (Moderate, Strong)
Comments: Treatment should be continued for at least 6 months after discontinuation of immunosuppressive therapy (at least 12 months for B cell– depleting agents).
612

The AGA suggests antiviral prophylaxis over monitoring for patients at moderate risk undergoing immunosuppressive drug therapy. (Moderate, Conditional (weak))
Comments: Treatment should be continued for 6 months after discontinuation of immunosuppressive therapy. Patients who place a higher value on avoiding long-term use of antiviral therapy and the cost associated with its use and a lower value on avoiding the small risk of reactivation (particularly in those who are HBsAg negative) may reasonably select no prophylaxis over antiviral prophylaxis.
612

The AGA suggests against routinely using antiviral prophylaxis in patients undergoing immunosuppressive drug therapy who are at low risk for HBVr. (Moderate, Conditional (weak))
612

The AGA suggests against using anti-HBs status to guide antiviral prophylaxis for all risk groups. (Very Low, Conditional (weak))
612

The AGA suggests use of antiviral drugs with a high barrier to resistance over lamivudine for prophylaxis in patients undergoing immunosuppressive drug therapy. (Moderate, Conditional (weak))
Comments: Given the geographic variability in cost of antiviral therapy, those patients who put a higher value on cost and a lower value on avoiding the potentially small risk of resistance development (particularly in those who have an undetectable viral load and who are expected to use antiviral prophylaxis for £6 months) may reasonably select the least expensive antiviral hepatitis B medication over more expensive antiviral drugs with a higher barrier to resistance.
612

The AGA makes no recommendation for a strategy of HBV DNA monitoring followed by rescue treatment as an alternative to antiviral prophylaxis. (Evidence Gap, No recommendation)
612

The AGA recommends antiviral drugs with a high barrier to resistance over lamivudine for established HBVr in patients undergoing immunosuppressive drug therapy. (Moderate, Strong)
612

The AGA recommends screening for HBV (HBsAg and anti-HBc, followed by a sensitive HBV DNA test if positive) in patients at moderate or high risk who will undergo immunosuppressive drug therapy. (Moderate, Strong)
612
Comments: Patients in populations with a baseline prevalence likely exceeding 2% for chronic HBV should be screened according to Centers for Disease Control and Prevention and US Preventive Services Task Force recommendations.

Recommendation Grading

Overview

Title

Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy

Authoring Organization

Publication Month/Year

January 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D006510 - Hepatitis B Antibodies, D006509 - Hepatitis B

Keywords

hepatitis B, HBV

Methodology

Number of Source Documents
106
Literature Search Start Date
July 1, 2005
Literature Search End Date
September 1, 2013