The development of effective nucleos(t)ide analogs (
NAs) against hepatitis B virus (HBV) has improved the outcome of patients with
chronic hepatitis B (CHB). This review updates issues related to the management of CHB patients included in special populations.
Entecavir (ETV) and
tenofovir (TDF) represent the currently recommended first-line
NAs in patients with HBV decompensated
cirrhosis. The combination of HBV
immunoglobulin (usually for a finite duration) and NA is considered the standard of care for prophylaxis against HBV recurrence after
liver transplantation. TDF is the best choice for
hemodialysis patients and in patients with
chronic kidney disease with
nucleoside resistance. ETV and
telbivudine are the preferred options in naïve renal transplant recipients and with low
viremia levels, respectively. All
hepatitis B surface antigen (
HBsAg)-positive candidates should be treated with
NAs before
renal transplantation to achieve undetectable HBV
DNA at the time of
transplantation. Conventional
interferon or
NAs can also be used in children, on the basis of well-established therapeutic indication. Pregnant women at high risk of perinatal transmission could be treated with
lamivudine,
telbivudine or TDF in the last trimester of pregnancy.
HBsAg-positive patients under immunosuppression should receive NA pre-emptively (regardless of HBV
DNA levels) up to 12 mo after its cessation. In
HBsAg negative, anti-HBc positive patients under immunosuppression, further studies are needed to form a final conclusion; however, it seems that anti-HBV prophylaxis is justified in such patients with
hematological diseases and/or for those receiving
rituximab-containing regimens, regardless of their anti-HBs or serum HBV
DNA status.