Despite the excitement regarding Hepatitis C, Hepatitis A and Hepatitis B remain important challenges. Here’s the latest:
1. Collier MG, et al. “Hepatitis A Hospitalizations in United States, 2002-2011” Hepatology 2015; 61: 481-85. The authors examined the changes in demographics and frequency of HAV hospitalization during the study period. Key findings:
- Rates of hospitalization dropped from 0.72/100,000 to 0.29/100,000.
- Average age of hospitalized patient increased from 37.6 years to 45.5 years and more comorbidities were noted.
- No changes were noted in length-of-stay or in-hospital deaths
2. DiBisceglie AM et al. “Recent US Food and Drug Administration Warnings on Hepatitis B Reactivation with Immune-Suppressing and Anticancer Drugs: Just the Tip of the Iceberg?” Hepatology 2015; 61: 703-11. Key recommendation: “There is good evidence to support routine screening of all patients for hepatitis B prior to undergoing chemotherapy or immunosuppressive treatment; use of prompt antiviral treatment appears to diminish the risk of severe or fatal reactivation of hepatitis B. Different organizations suggest disparate screening recommendations (Table 4). AASLD suggests HBsAg, and anti-HBc. CDC suggests adding anti-HBs.
3. Reddy KR, et al. Gastroenterology 2015; 148: 215-19, technical review 221-44. AGA Guideline on the Prevention and Treatment of HBV Reactivation During Immunosuppressive Therapy. Key Recommendations:
- Screen patients with HBsAg and anti-HBc, followed by a sensitive HBV DNA test if positive
- Treat at-risk patients with antivirals with high barrier to resistance for at least 6 months after discontinuation of immunosuppressive therapy (except in patients taking B cell depleting agents who it is recommended to treat for at least 12 months afterwards)
Reactivation risk: (For all of the specifics — Full text article link)
- High risk of reactivation (>10%): B cell depleting agents (eg. rituximab, ofatumumab), anthracycline derivatives (eg. doxorubicin, epirubicin), and daily moderate to high dose steroids (>10 mg) for at least 4 weeks.
- Moderate risk of reactivation (1-10%): anti-TNF therapy, integrin inhibitors (eg. ustekinimab, vedolizumab), tyrosine kinase inhibitors, low-dose steroids daily (<10 mg/day) for at least 4 weeks (if HBsAg-positive but not if only anti-HBc-positive)
- Low risk of reactivation (<1%): azathiopurine, 6-mercaptopurine, methotrexate. No antiviral prophylaxis required.
For those interested in a more detailed summary of the recommendations: AGA Website HBV Reactivation Recommendations
4. Corsa AC et al. “No Resistance to Tenofovir Disoproxil Fumarate Through 96 Weeks of Treatment in Patients with Lamivudine-Resistant Chronic Hepatitis B. Clin Gastroenterol Hepatol 2014; 12: 2106-12. This study followed 280 patients–no resistance to tenofovir was observed.
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