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Gastroenterology18 papers

Reactivation of hepatitis C viral hepatitis

Last edited: 4/10/2026

Overview

Hepatitis B reactivation (HBVr) is a significant cause of liver-related morbidity and mortality, particularly in individuals receiving immune-modulating therapies 13. It can occur due to various drug classes and disease states that suppress the immune system 1.

Diagnosis

  • Screen all patients for hepatitis B prior to initiating immunosuppressive therapy 3.

    • Management

  • Antiviral prophylaxis can be effective in mitigating the risk of HBVr 1.
  • In select cases, clinical monitoring without antiviral prophylaxis may be sufficient 1.
  • Administer pre-emptive nucleos(t)ide analogues to patients with a substantial risk of HBVr and acute-on-chronic liver failure 3.
  • Risk-stratify immunosuppressive therapy based on its reported rate of hepatitis B reactivation 3.

    • Key Recommendations

  • For individuals at high risk of HBVr, antiviral prophylaxis is recommended 1. (Evidence: Strong)
  • For individuals at moderate risk of HBVr, antiviral prophylaxis is conditionally recommended 1. (Evidence: Moderate)
  • Screen all patients for hepatitis B before starting immunosuppressive therapy 3. (Evidence: Expert opinion)
  • Administer pre-emptive nucleos(t)ide analogues to patients with a substantial risk of HBVr and acute-on-chronic liver failure 3. (Evidence: Expert opinion)

    • References

    1 Ali FS, Nguyen MH, Hernaez R, Huang DQ, Wilder J, Piscoya A et al.. AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals. Gastroenterology 2025. link 2 Perazzo H, Castro R, Villela-Nogueira C, Torres M, Silva SL, Cardoso SW et al.. Acceptability and usability of oral fluid HCV self-testing for hepatitis C diagnosis: A systematic review and meta-analysis. Journal of viral hepatitis 2023. link 3 Lau G, Yu ML, Wong G, Thompson A, Ghazinian H, Hou JL et al.. APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy. Hepatology international 2021. link

    Original source

    1. [1]
      AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals. — Ali FS, Nguyen MH, Hernaez R, Huang DQ, Wilder J, Piscoya A et al. Gastroenterology (2025)
    2. [2]
      Acceptability and usability of oral fluid HCV self-testing for hepatitis C diagnosis: A systematic review and meta-analysis. — Perazzo H, Castro R, Villela-Nogueira C, Torres M, Silva SL, Cardoso SW et al. Journal of viral hepatitis (2023)
    3. [3]
      APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy. — Lau G, Yu ML, Wong G, Thompson A, Ghazinian H, Hou JL et al. Hepatology international (2021)
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