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REVIEW ARTICLE
Year : 2008  |  Volume : 5  |  Issue : 1  |  Page : 23-50

Prophylaxis and treatment of Hepatitis B in immunocompromised patients


1 Division of Gastroenterology and Hepatology, AOU San Giovanni Battista, Torino, Italy
2 Division of Gastroenterology, Fondazione Policlinico, Mangiagalli Regina Elena, IRCCS Maggiore Hospital, University of Milan, Milano, Italy

Correspondence Address:
Alfredo Marzano
Division of Gastroenterology, AOU San Giovanni Battista, Corso Bramante 88, 10125, Torino
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9747.58804

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The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Today a rational approach to the problem of hepatitis B in these patients provides for: a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), b) the treatment with antivirals (therapy) of active carriers, c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, d) the biochemical and HBsAg monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous contact with HBV (HBsAg-negative and antiHBc-positive), in order to prevent reverse seroconversion. Moreover it is suggested a strict adherence to the criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants, and in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg-positive candidates and in HBsAg-negative recipients of antiHBc-positive grafts should be adopted.


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