乙型肝炎病毒(HBV)在接受化疗的患者再激活,生物制品,免疫抑制剂,或皮质类固醇正在成为当前或先前暴露于HBV感染的患者的发病率和死亡率的重要原因。这些患者遭受疾病的双重冲击:他们正在接受导致HBV再激活的罪魁祸首药物的主要疾病之一,另一个来自HBV本身的再激活。HBV再激活不仅导致肝功能受损,这可能最终导致肝功能衰竭;它也对原发疾病的治疗结果产生不利影响。因此,在开始使用这些药物之前,确定有重新激活风险的患者,和开始治疗旨在预防HBV再激活是管理这些患者的最佳策略。在接受化疗的患者中,没有关于HBV感染管理的印度指南,生物制品,免疫抑制剂,或用于治疗风湿病的皮质类固醇,恶性肿瘤,炎症性肠病,皮肤病,或实体器官或骨髓移植。印度全国肝脏研究协会(INASL)在2016年成立了一个关于HBV的工作组,其任务是为HBV感染的各个方面的管理制定共识指南,与印度有关。2017年,工作组发布了印度第一个关于HBV感染管理的INASL指南。在本准则中,这些都是先前准则的延续,化疗患者HBV感染的管理问题,生物制品,免疫抑制剂,或皮质类固醇得到解决。
Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian
guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop
consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published the first INASL
guidelines on management of HBV infection in India. In the present
guidelines, which are in continuation with the previous
guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids are addressed.