APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau, George; Yu, Ming-Lung; Wong, Grace; Thompson, Alexander; Ghazinian, Hasmik; Hou, Jin-Lin; Piratvisuth, Teerha; Jia, Ji-Dong; Mizokami, Masashi; Cheng, Gregory; Chen, Guo-Feng; Liu, Zhen-Wen; Baatarkhuu, Oidov; Cheng, Ann Lii; Ng, Woon Leung; Lau, Patrick; Mok, Tony; Chang, Jer-Ming; Hamid, Saeed; Dokmeci, A. Kadir; Gani, Rino A.; Payawal, Diana A.; Chow, Pierce; Park, Joong-Won; Strasser, Simone I.; Mohamed, Rosmawaiti; Win, Khin Maung; Tawesak, Tanwandee; Sarin, Shiv Kumar; Omata, Masao

BACKGROUND & AIM: Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liver-related morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. METHODS: All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. RECOMMENDATIONS: We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.