Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1738-1748
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1738
Management of patients with hepatitis B in special populations
Evangelos Cholongitas, Konstantinos Tziomalos, Chrysoula Pipili
Evangelos Cholongitas, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54642 Thessaloniki, Greece
Chrysoula Pipili, Department of Nephrology, Laiki Merimna, 14232 Athens, Greece
Author contributions: Cholongitas E and Pipili C contributed equally to this paper; all authors participated in writing the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evangelos Cholongitas, Assistant Professor, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 49 Konstantinopoleos Street, 54642 Thessaloniki, Greece. cholongitas@yahoo.gr
Telephone: +30-231-0892110 Fax: +30-231-0992940
Received: September 8, 2014
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: October 27, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: February 14, 2015
Processing time: 156 Days and 16.4 Hours
Abstract

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.

Keywords: Hepatitis B; Antiviral therapy; Tenofovir; Entecavir; Telbivudine

Core tip: The management of hepatitis B virus (HBV) infection in special populations is reviewed. HBV patients with decompensated cirrhosis should receive nucleos(t)ides analogs (NAs) before and after liver transplantation. The choice of NA for patients with chronic kidney disease, renal transplant candidates and recipients depends on viremia levels, the severity of renal dysfunction and previous viral resistance. Children at the immune-active period may receive interferon or NAs. Pregnant women at risk of perinatal transmission should receive class B antiviral drugs or LAM. HBV patients receiving immunosuppressives should receive antiviral therapy based on HBV serological profile, HBV DNA detectability and intensity of immunosuppression.