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Gastroenterology 2015;-:1–2
AGA SECTION AGA Hepatitis B Virus Reactivation Guideline: Patient Summary Q4
American Gastroenterological Association
H
epatitis B (HBV) is a virus that affects the liver. Not everyone with HBV will have symptoms when they are infected. HBV will usually go away on its own within 6 months, but sometimes it becomes a long-term (chronic) infection. The DNA of the virus can stay in the body even after the initial infection goes away, and infection may be reactivated under certain conditions. Drugs that weaken the immune system may increase an individual’s risk for HBV reactivation, which can cause life-threatening liver problems. The AGA guideline can help your doctor tell whether you are at risk of reactivation, and how best to prevent it from happening.
Hepatitis B Virus Is an infection That Affects the Liver Hepatitis B Virus (HBV) spreads through sexual contact and through sharing infected objects such as needles and razors. It can also pass from mother to baby during birth. Some people with HBV infection will have symptoms, but others will not. Symptoms of HBV usually occur 1 to 6 months after a person is infected. Symptoms of HBV include: feeling tired getting sick or throwing up stomach pain diarrhea body aches yellowing of the skin and eyes HBV infection can be either acute or chronic.
Acute Infection In an acute infection, the body’s immune system naturally fights off the virus. The patient should be healthy again within 6 months. Most people with acute HBV do not need to take medicine. To help their body fight the infection, a person with HBV should:
95% of babies who are infected with HBV will develop a chronic infection. Chronic HBV can cause serious liver damage and scarring. It can also lead to liver cancer or liver failure. Chronic HBV can be treated with antiviral drugs that lower the amount of HBV in the blood. Sometimes, these drugs can totally remove HBV from the blood.
Hepatitis B Reactivation Happens When the Amount of HBV in a Person’s Blood Quickly Increases A few weeks after reactivation starts, the infected person’s liver will become swollen and tender, and may stop working well. When the liver is affected by HBV, it gives off a chemical called alanine aminotransferase, or ALT. During this time, a person’s skin and eyes may turn yellow, and their urine may turn dark. This is called jaundice (JON-diss), Q1 and it is caused by having too much of a certain chemical, called bilirubin, in the blood. Doctors test for reactivation by measuring the change in HBV, ALT, and bilirubin levels in a person’s blood.
Anyone Who Has Ever had HBV Is at Risk of Reactivation People with chronic HBV are more likely to have reactivation. However, a person who had acute HBV in the past is also at risk. This is because the DNA of the virus can stay in a person’s body even after they are healthy again. A reactivation of HBV can be fatal. Reactivation can happen when someone with past or current HBV infection takes certain medicines that can weaken the immune system. Immune-weakening drugs, or immunosuppressants (imm-YOO-no-sup-RESS-uhnts), are Q2 used to treat many diseases, including: Lymphoma and leukemia Solid tumor cancers, such as breast or lung cancer Rheumatoid arthritis
get lots of rest
Certain blood disorders
drink lots of fluids
Inflammatory bowel disease (IBD)
eat a healthy diet
Vasculitis
not drink alcohol or do drugs
Other autoimmune disorders
Chronic Infection Sometimes, HBV turns into a chronic disease. This means that it lasts longer than 6 months. Five percent of adults and
© 2015 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2015.06.041
PGL 5.2.0 DTD YGAST59875_proof 27 June 2015 1:21 pm ce
AGA SECTION
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Gastroenterology Vol.
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No.
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Your Doctor Can Use the AGA Guideline until 6 months after stopping immunosuppressants. Others may decide not to take them. to Measure Your Risk and Decide Whether to Prescribe Antiviral Drugs Low Risk to Help Prevent Reactivation Low risk means you are less than 1% likely to have HBVr If you have ever been infected with HBV, and are taking drugs for any of the conditions above, ask your doctor about your risk of reactivation. Your level of risk depends on several factors, including: the type of drug you are taking how long you have been taking the drug your type of HBV infection (acute or chronic) whether your blood was ever clear of the virus
while taking immunosuppressants. Most patients at low risk would not need to be tested for HBV and generally do not need to take antiviral drugs.
Questions to Ask Your Doctor If You Are Taking Immunosuppressants Have I been vaccinated for HBV? If not, should I be vaccinated? What is my risk of carrying HBV?
High Risk High risk means that you are more than 10% likely to have reactivation while taking immunosuppressants. If you are at high risk, your doctor should always test your blood to see whether you were ever infected with HBV. You doctor should also prescribe an antiviral drug to prevent reactivation. High-risk patients should take antiviral drugs as long as they are taking immunosuppressants, and for 6–12 months after stopping them.
Should I be screened for HBV? If I have HBV, what is my risk of reactivation?
If You Have a Past or Current HBV Infection Do I have any risk factors for HBV reactivation? What can I do to help prevent reactivation?
Medium Risk Some drugs give you a medium risk of HBVr. A medium risk would mean that you are 1%–10% likely to have HBV reactivation while taking immunosuppressants. All mediumrisk patients need to be tested for HBV and should talk to their doctor about the pros and cons of taking antiviral drugs. Some patients may choose to take antiviral drugs
Reference 1.
Reddy RK, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015;148:215–219.
AGA SECTION
121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180
AGA Section
PGL 5.2.0 DTD YGAST59875_proof 27 June 2015 1:21 pm ce
Q3
181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240
Gastroenterology 2015;-:1–2
AGA SECTION AGA Hepatitis B Virus Reactivation Guideline: Patient Summary Q4
American Gastroenterological Association
H
epatitis B (HBV) is a virus that affects the liver. Not everyone with HBV will have symptoms when they are infected. HBV will usually go away on its own within 6 months, but sometimes it becomes a long-term (chronic) infection. The DNA of the virus can stay in the body even after the initial infection goes away, and infection may be reactivated under certain conditions. Drugs that weaken the immune system may increase an individual’s risk for HBV reactivation, which can cause life-threatening liver problems. The AGA guideline can help your doctor tell whether you are at risk of reactivation, and how best to prevent it from happening.
Hepatitis B Virus Is an infection That Affects the Liver Hepatitis B Virus (HBV) spreads through sexual contact and through sharing infected objects such as needles and razors. It can also pass from mother to baby during birth. Some people with HBV infection will have symptoms, but others will not. Symptoms of HBV usually occur 1 to 6 months after a person is infected. Symptoms of HBV include: feeling tired getting sick or throwing up stomach pain diarrhea body aches yellowing of the skin and eyes HBV infection can be either acute or chronic.
Acute Infection In an acute infection, the body’s immune system naturally fights off the virus. The patient should be healthy again within 6 months. Most people with acute HBV do not need to take medicine. To help their body fight the infection, a person with HBV should:
95% of babies who are infected with HBV will develop a chronic infection. Chronic HBV can cause serious liver damage and scarring. It can also lead to liver cancer or liver failure. Chronic HBV can be treated with antiviral drugs that lower the amount of HBV in the blood. Sometimes, these drugs can totally remove HBV from the blood.
Hepatitis B Reactivation Happens When the Amount of HBV in a Person’s Blood Quickly Increases A few weeks after reactivation starts, the infected person’s liver will become swollen and tender, and may stop working well. When the liver is affected by HBV, it gives off a chemical called alanine aminotransferase, or ALT. During this time, a person’s skin and eyes may turn yellow, and their urine may turn dark. This is called jaundice (JON-diss), Q1 and it is caused by having too much of a certain chemical, called bilirubin, in the blood. Doctors test for reactivation by measuring the change in HBV, ALT, and bilirubin levels in a person’s blood.
Anyone Who Has Ever had HBV Is at Risk of Reactivation People with chronic HBV are more likely to have reactivation. However, a person who had acute HBV in the past is also at risk. This is because the DNA of the virus can stay in a person’s body even after they are healthy again. A reactivation of HBV can be fatal. Reactivation can happen when someone with past or current HBV infection takes certain medicines that can weaken the immune system. Immune-weakening drugs, or immunosuppressants (imm-YOO-no-sup-RESS-uhnts), are Q2 used to treat many diseases, including: Lymphoma and leukemia Solid tumor cancers, such as breast or lung cancer Rheumatoid arthritis
get lots of rest
Certain blood disorders
drink lots of fluids
Inflammatory bowel disease (IBD)
eat a healthy diet
Vasculitis
not drink alcohol or do drugs
Other autoimmune disorders
Chronic Infection Sometimes, HBV turns into a chronic disease. This means that it lasts longer than 6 months. Five percent of adults and
© 2015 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2015.06.041
PGL 5.2.0 DTD YGAST59875_proof 27 June 2015 1:21 pm ce
AGA SECTION
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120
2
Gastroenterology Vol.
-,
No.
-
Your Doctor Can Use the AGA Guideline until 6 months after stopping immunosuppressants. Others may decide not to take them. to Measure Your Risk and Decide Whether to Prescribe Antiviral Drugs Low Risk to Help Prevent Reactivation Low risk means you are less than 1% likely to have HBVr If you have ever been infected with HBV, and are taking drugs for any of the conditions above, ask your doctor about your risk of reactivation. Your level of risk depends on several factors, including: the type of drug you are taking how long you have been taking the drug your type of HBV infection (acute or chronic) whether your blood was ever clear of the virus
while taking immunosuppressants. Most patients at low risk would not need to be tested for HBV and generally do not need to take antiviral drugs.
Questions to Ask Your Doctor If You Are Taking Immunosuppressants Have I been vaccinated for HBV? If not, should I be vaccinated? What is my risk of carrying HBV?
High Risk High risk means that you are more than 10% likely to have reactivation while taking immunosuppressants. If you are at high risk, your doctor should always test your blood to see whether you were ever infected with HBV. You doctor should also prescribe an antiviral drug to prevent reactivation. High-risk patients should take antiviral drugs as long as they are taking immunosuppressants, and for 6–12 months after stopping them.
Should I be screened for HBV? If I have HBV, what is my risk of reactivation?
If You Have a Past or Current HBV Infection Do I have any risk factors for HBV reactivation? What can I do to help prevent reactivation?
Medium Risk Some drugs give you a medium risk of HBVr. A medium risk would mean that you are 1%–10% likely to have HBV reactivation while taking immunosuppressants. All mediumrisk patients need to be tested for HBV and should talk to their doctor about the pros and cons of taking antiviral drugs. Some patients may choose to take antiviral drugs
Reference 1.
Reddy RK, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015;148:215–219.
AGA SECTION
121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180
AGA Section
PGL 5.2.0 DTD YGAST59875_proof 27 June 2015 1:21 pm ce
Q3
181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240
