Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention
Suharjo Broto Cahyono(1*), Neneng Rasari Neneng Rasari(2), Putut Bayupurnama(3), Sutanto Maduseno(4), Siti Nurdjanah(5)
(1) 
(2) 
(3) 
(4) 
(5) 
(*) Corresponding Author
Abstract
Almost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 million
of these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acute
exacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with or
without sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compounded
in use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,
reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiate
between acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important for
deciding whether to start treatment or not, because acute hepatitis B does not require treatment, while
reactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivation
or fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.
Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ide
analogues
Full Text:
PDFReferences
REFERENCES
Hwang EW., Cheung R. Global epidemiology of hepatitis B virus (HBV) infection. North Am J of Med Science 2011: 4: 7–13.
Fattovich G., Bortolotti F., Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factor. J hepatol 2008; 48; 335–352.
Franco E., Bagnato B., Marino MG., Meleleo C., Serino L., Zaratti L. Hepatitis B: epidemiology and prevention in developing countries. World J of Hepatology 2012: 4: 74–80.
Jindal A., Kumar M., Sarin SK. Management of acute hepatitis B and reactivation of hepatitis B. Liver International 2013; 164- 175.
Harroch EO., Levy L., Chetrit EB. Acute hepatitis B or exacerbation of chronic hepatitis B that is the question. World J Gastroenterol 2008: 14; 7133–7137.
Busca A., Kumar A. Innate immune responses in hepatitis B virus (HBV) infection. Virology J 2014: 11-22.
Pungpapong S., Kim WR., Poterucha JJ. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clinic Proc 2007; 82; 967–975.
GanemD., Prince AM. Hepatitis B virus infection – natural history and clinical consequences. N Engl J Med 2004; 350; 1118 –29.
Guigis M., Zekry A. Natural history of chronic hepatitis B virus infection. http://www.ashm.org.au/images/publications/monographs/b%20position/b_chapter_4.pdf
Sherman MS., Shafran S., Burak K., et al., Canadian Consensus Guidelines. Management of chronic hepatitis B: consensus guidelines. Can J Gastroenterol 2007; 21; 5C–24 C.
McMahon BJ. The natural history of chronic hepatitis B virus infection. Hepatology 2009:49: 45-55.
Liang TJ. Hepatitis B: the virus and disease.Hepatology 2009: 49: S13–S 21.
Pan CQ and Zhang JX., Natural history and clinical consequences of hepatitis B viral infection. Int J Med Sci 2005; 2; 36–40.
Anna SFL and McMahon BJ. The American Association for the Study of Liver Disease: Chronic hepatitis B. Hepatology 2007: 507–539.
Hoofnagles JH. Reactivation of hepatitis B. Hepatology 2009; 49; S 156–S 165.
Lau GK. Hepatitis B reactivation after chemotherapy: two decades of clinical research. Hepatology International. 2008: 2; 152–162.
Sarin SK., Kumar A., Almeida JA. Acuteon- chronic liver failure:consensus recommendations of the Asian Pacific The Journal of Internal Medicine, Acta Interna, Volume 4, Number 1, June 2014: 40-49
Association for study of the liver (APASL). Hepatol Int 2009; 3: 269–282.
Soemohardjo S., and Gunawan S., Acute exacerbation of chronic hepatitis B infection.http://www.biomedikamataram.wordpress.com/2009/07/13/acuteexacerbation-of-chronis-hepatitis-binfection.pdf
Kawsar HI., Shahnewaz J., Gopalakrishna KV., Spiro TP., Daw HA. Hepatitis B reactivation in cancer patients: role of prechemotherapy screening and antiviral prophylaxis. Clin Advance in Hem & Oncology 2012: 10: 370–378.
Garg H., Sarin SK., Kumar M., Garg V., Sharma BC., Kumar A. Tenofi r improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. Hepatology 2011; 53: 774–780.
Roche B and Samuel D. The diffi culties of managing severe hepatitis B virus reactivation. Liver International 2011; 31; 104–110.
Lubel JS and Angus PW. Hepatitis B reactivation in patients receiving cytotoxic chemotherapy: diagnosis and management. J of Gastroenterol and Hepatol 2010: 25; 864- 871.
Kumar M., Jain S., Sharma BC., et al. Differentiating acute hepatitis B from the first episode of symptomatic exacerbation of chronic hepatitis B. Dig Dis Sci 2006; 51; 594–9.
Wong SW and Chan LY. Severe acute exacerbation of chronic hepatitis B: a unique presentation of a common disease. J of Gastroenterol and Hepatol 2009; 24; 1179–1186.
Yeo W and Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006; 43: 209-220.
Chien RN., Lin CH., Liaw YF. The effect of lamivudine therapy in hepatic decompensation during acute exacerbation of chronic hepatitis B. J of Hepatology 2003; 38; 322–327.
Lok ASF., Ward JW., Perillo RP., et al. Reactive of hepatitis B during immunosuppressive therapy: potentially fatal yet preventable. Ann Inter Med 2012; 156; 743–745.
Tran TT., Rakoski MO., Martin P. Screening for hepatitis B in chemotherapy patients: survey of current oncology practices. Aliment Pharmacol Ther. 2010; 31; 240-6.
Day FL., Link E., Thursky K., Rischin D. Curent hepatitis B screening practices and clinical experience of reactivation in patients undergoing chemotherapy for solid tumors: a national survey of medical oncologists. J of Oncology Practice 2011: 7: 141–147.
Zobeiri M. Occult hepatitis B: clinical viewpoint and management. Hepatitis Research and Treatment 2013: Article ID 259148, 7 pages. http://dx.doi.org/10.1155/2013/259148
Huang YH., Lin HC., Lee SD. Management of chemotherapy-induced hepatitis B virus reactivation. J Chinese Med Association 2012: 75: 359–362.
DOI: https://doi.org/10.22146/acta%20interna.5351
Article Metrics
Abstract views : 1352 | views : 3470Refbacks
- There are currently no refbacks.
Copyright (c) 2014 Acta Interna The Journal of Internal Medicine
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Acta Interna The Journal of Internal Medicine Indexed by:
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.