Due to the inherent relationship between the immune system and the hepatitis B virus (HBV) in exposed and infected individuals,
immunomodulation associated with the treatment of solid tumours, haematological
malignancies and inflammatory disorders has been linked to HBV reactivation (HBVr). Reactivation of HBV
infection in the setting of
chemotherapy and immunosuppression may lead to
fulminant liver failure and death, but there is a cumulative body of evidence that these are potentially preventable adverse outcomes. As
chronic hepatitis B is largely asymptomatic but also endemic worldwide, clinicians caring for patients requiring
chemotherapy or immunosuppression need to be vigilant of the potential for HBVr in susceptible individuals. Serological screening and prophylactic and pre-emptive
antiviral treatment with a nucleos(t)ide analogue should be considered in appropriate settings.
Hepatitis B prevalence is examined in this review article, as are the risks of HBVr in patients receiving chemo- and immunosuppressive therapy. Recommendations regarding screening, monitoring and the role of
antiviral prophylaxis are outlined with reference to current international associations' guidelines and the best available evidence to date.