免疫缺陷患者慢性HBV感染的管理

Gui-Qiang Wang*. Professor and Director， Dept. of Infectious Diseases， and Director， Center for Liver Diseases， Peking University First Hospital， Beijing， China

The immunosuppression by chemotherapy or immunosuppressive therapy in chronic hepatitis B virus (HBV) infection is an increasing risk for reactivation of hepatitis B and may lead to acute hepatitis， chronic hepatitis， or even fulminant hepatitis and death. Several studies have shown a significant benefit by antiviral therapy with lamivudine to avoid reactivation， and the prophylaxis with antiviral agents should be superior to therapy of reactivation.

A rational approach to avoid the reactivation hepatitis B in these patients has been developed， including (a) the evaluation of HBV markers and liver condition in all patients before starting immunosuppressive therapies; (b) the vaccination to patients without detection of HBsAg or without sufficient anti-HBs-titer; (c) the treatment with antiviral agents of chronic hepatitis B patients; (d) the prophylaxis use of antiviral agents such as lamivudine in all HBsAg positive carriers; (d) the biochemical， HBsAg and HBV DNA monitoring in subjects with HBsAg negative and anti-HBc positive， or in subjects with markers of previous contact with HBV; (e) the prophylaxis use of antiviral agents before intense immunosuppression such as bone marrow transplantation if anti-HBc positive， independent from HBsAg result.

Lamivudine has been approved to be effective and safe in the management of immunosuppressive patients， other nucleoside analogues (telbivudine， entecavir) or nucleotide analogues (adefovir dipivoxil， tenofovir) are potential candidates in this situation， but larger experiences are yet missing.