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Abstract：
This editorial commented on an article in the World Journal of Gastroenterology titled \"Risks of Reactivation of Hepatitis B Virus in Oncological Patients Using Tyrosine Kinase-Inhibitors: Case Report and Literature Analysis\" by Colapietro et al. In this editorial, we focused on providing a more comprehensive exploration of hepatitis B virus reactivation (HBVr) associated with the usage of tyrosine kinase inhibitors (TKIs). It includes insights into the mechanisms underlying HBV reactivation, the temporal relationship between TKIs and HBV reactivation, and preventive measures. The aim is to understand the need for nucleos(t)ide analogs (NAT) and serial blood tests for early recognition of reactivation and acute liver injury, along with management strategies. TKIs are considered to be an intermediate (1%-10%) of HBVr. Current guidelines stipulate that patients receiving therapy with high or moderate risks of reactivation or recent cancer diagnosis must have at least tested hepatitis B surface antigen, anti-hepatitis B core antigen (HBc), and anti-hepatitis B surface antibody. Anti-HBc screening in highly endemic areas means people with negative tests should be vaccinated against HBV. Nucleoside or nucleotide analogs (NAs) like entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) form the basis of HBV reactivation prophylaxis and treatment during immunosuppression. Conversely, lamivudine, telbivudine, and adefovir are generally discouraged due to their reduced antiviral efficacy and higher risk of fostering drug-resistant viral strains. However, these less effective NAs may still be utilized in cases where ETV, TDF, and TAF are not feasible treatment options.
摘要：
这篇社论评论了《世界胃肠病学杂志》上一篇题为“使用酪氨酸激酶抑制剂的肿瘤患者乙型肝炎病毒再激活的风险：病例报告和文献分析”的文章。在这篇社论中，我们专注于提供更全面的探索与酪氨酸激酶抑制剂（TKIs）使用相关的乙型肝炎病毒再激活（HBVr）。它包括对潜在的HBV再激活机制的见解，TKIs与HBV再激活的时间关系，和预防措施。目的是了解需要核苷（t）ide类似物（NAT）和系列血液测试的早期识别的再激活和急性肝损伤，以及管理策略。TKI被认为是HBVr的中间体(1%-10%)。目前的指南规定，患者接受治疗与高或中度风险的再激活或最近的癌症诊断必须有至少测试乙肝表面抗原，抗乙型肝炎核心抗原（HBc），和抗乙型肝炎表面抗体。在高流行地区进行抗HBc筛查意味着测试阴性的人应该接种HBV疫苗。核苷或核苷酸类似物（NAs）如恩替卡韦（ETV），富马酸替诺福韦酯（TDF），替诺福韦艾拉酚胺（TAF）是免疫抑制期间HBV再激活预防和治疗的基础。相反，拉米夫定,替比夫定,和阿德福韦通常是不鼓励，因为它们的抗病毒功效降低和培养耐药病毒株的风险较高。然而,在ETV，TDF,和TAF不是可行的治疗选择。
