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New AGA Guidelines Address Hepatitis B Risk


— January 23, 2025

The AGA’s updated guidelines help prevent hepatitis B reactivation in immunosuppressed patients.


The American Gastroenterological Association (AGA) has introduced updated guidelines for preventing and managing hepatitis B reactivation (HBVr) in patients taking medications that weaken the immune system. These drugs, which are used to treat conditions such as cancer, autoimmune diseases, and gastrointestinal issues, have become more common over the years. As the number of patients using these treatments grows, so does the number of individuals experiencing the reactivation of hepatitis B, which can cause serious liver damage, including failure, and may even require a liver transplant.

For those at high risk of hepatitis B reactivation, the AGA recommends starting antiviral treatment to prevent complications. This type of treatment can prevent liver damage, hospitalization, or even death, which are much more severe than any side effects of the medication itself. For patients who do not start antiviral medication, careful monitoring is essential to catch any potential reactivation early. Thankfully, effective antiviral treatments are readily available in the U.S.

The guidelines highlight that both current hepatitis B patients and those who were previously exposed to the virus—whether they have immunity or not—are at risk of reactivation when undergoing immunosuppressive treatments. Screening for hepatitis B before starting these treatments is a key step in preventing problems. The U.S. Centers for Disease Control and Prevention (CDC) now recommends that all adults be tested for hepatitis B at least once in their lifetime. A three-part screening test can identify who might be at risk for reactivation.

New AGA Guidelines Address Hepatitis B Risk
Photo by Miguel Á. Padriñán from Pexels

The AGA’s updated guidance categorizes patients based on their risk of reactivation, depending on the medication they are taking. There are three groups: high, moderate, and low risk. Patients who are on stronger immunosuppressive medications, like chemotherapy or biologic treatments, fall into the high-risk category. Moderate risk includes those on therapies like low-dose steroids or treatments for specific cancers. Low-risk patients include those on mild doses of medications like steroids for short periods.

Understanding hepatitis B reactivation is important. When someone has been exposed to the virus, it can lie dormant in their body for years. Sometimes, it can become active again, causing serious liver damage, including liver failure or the need for a transplant. Hepatitis B reactivation can also lead to death in severe cases. Patients who are at the highest risk of reactivation include those with chronic hepatitis B or who were previously exposed to the virus. Those who take medications that suppress the immune system, such as chemotherapy, medications for autoimmune diseases, and transplant drugs, are particularly vulnerable.

It is essential for healthcare providers to be aware of these risks so they can take steps to prevent hepatitis B reactivation in patients who may be at high risk. This includes starting antiviral treatment before beginning immunosuppressive therapies or closely monitoring those at moderate or low risk. By doing so, doctors can help protect the liver health of their patients while ensuring that they continue to benefit from the life-saving treatments they need.

The updated AGA guidelines serve as a helpful tool for managing hepatitis B reactivation in patients who need immunosuppressive therapy. By screening for the virus, classifying patients based on their risk, and offering antiviral medications or close monitoring when needed, healthcare providers can reduce the chances of severe liver damage and improve patient outcomes.

Sources:

AGA releases updated guidelines on hepatitis B reactivation in patients on immunosuppressive drugs

AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals

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