1 log copies/mL, either administered corticosteroid monotherapy, ZD1839 solubility dmso or administered standard chemotherapy for the treatment of solid malignancies.[313] Risk factors for HBV reactivation in HBsAg positive patients are HBeAg positive status and high HBV DNA levels. Although most patients with resolved HBV infection are positive for both anti-HBc and anti-HBs antibody, some are either anti-HBc antibody positive or anti-HBs antibody positive alone. Although anti-HBs antibody act to suppress HBV reactivation,

reactivation is still possible in patients positive for anti-HBs antibody alone.[315-317] HBV reactivation is commonly associated with hepatitis, which can vary from mild and transient hepatitis to severe and fatal. The onset of hepatitis associated with HBV reactivation is not always during immunosuppressive therapy or chemotherapy, but may occur after its interruption or cessation. this website In particular, severe hepatitis associated with HBV reactivation has been reported after cessation of corticosteroid and methotrexate therapy.[318-321] Moreover, conditions such as fibrosing cholestatic hepatitis (FCH) may present when viral replication is increased in the immunosuppressed state. [322, 323] Screening for HBV infection

should be performed in all patients undergoing immunosuppressive therapy or chemotherapy, irrespective of whether abnormalities of hepatic function are evident or not. HBsAg levels should be measured in all patients prior to commencement of treatment. In HBsAg positive patients, HBeAg, anti-HBe antibody, and HBV DNA levels should also be measured. A real-time PCR should

be used for measurement of HBV DNA levels. In HBsAg negative patients, anti-HBc antibody and anti-HBs antibody should also be measured. Patients positive for anti-HBc or anti-HBs antibody are diagnosed as patients with resolved HBV infection. However, this excludes those positive for anti-HBs antibody alone due to prior MCE hepatitis B vaccination. The next step for patients with resolved HBV infection is measurement of HBV DNA levels. For measurement of HBsAg, anti-HBc antibody and anti-HBs antibody, a highly sensitive test such as the CLIA or CLEIA method should be used. If HBV infection is diagnosed, the past history of hepatitis should be elicited, and screening for chronic liver disease performed, including abdominal ultrasonography. In HBV DNA positive patients, testing for HBV genotype, precore mutations and core promoter mutations is desirable. Recommendations Screening for HBV infection should be performed in all patients undergoing immunosuppressive therapy or chemotherapy, who are at risk of HBV reactivation.