HBV reactivation after immunosuppressive therapy and allogeneic HSCT – a silent threat in patients with chronic hepatitis B: a literature review
DOI:
https://doi.org/10.12775/JEHS.2026.88.69714Keywords
Hepatitis B virus, HBV reactivation, allogeneic hematopoietic stem cell transplantation, allo-HSCT, chronic hepatitis B, immunosuppression, antiviral prophylaxis, reactivation risk factorsAbstract
Chronic hepatitis B is a disease caused by infection with the hepatitis B virus (HBV), whose genetic material may exist either in an integrated form within the hepatocyte genome or as episomal covalently closed circular DNA (cccDNA). The persistence of cccDNA in host cells prevents complete viral eradication, even with effective antiviral therapy. In patients with undetectable surface antigen (HBsAg) and absent HBV DNA replication, infection may remain in an occult phase (OBI – occult HBV infection). However, during states of immunosuppression—such as oncologic or hematologic treatment and allogeneic hematopoietic stem cell transplantation (allo-HSCT)—there is a significant risk of viral reactivation, which may result in severe liver injury and worsen clinical outcomes. The aim of this review is to summarize current data on the mechanisms of HBV reactivation, risk factors, preventive strategies, and monitoring approaches in patients after immunosuppressive therapy or allo-HSCT. Particular emphasis is placed on the need for individualized therapeutic management and regular monitoring of liver function markers, as the clinical presentation does not always reflect the true extent of liver injury. Understanding the pathomechanisms of HBV reactivation and implementing appropriate preventive strategies remain crucial for improving the safety and efficacy of treatment in patients undergoing allo-HSCT.
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