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Guideline

Prevention and treatment of hepatitis B virus reactivation (HBVr) during immunosuppressive drug therapy

How to best prevent and treat hepatitis B virus reactivation (HBVr) resulting from immunosuppressive therapy.

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Recommendations

1. AGA recommends antiviral prophylaxis over no prophylaxis for patients at high risk undergoing immunosuppressive drug therapy.

2. AGA suggests antiviral prophylaxis over monitoring for patients at moderate risk undergoing immunosuppressive drug therapy.

3. AGA suggests against routinely using antiviral prophylaxis in patients undergoing immunosuppressive drug therapy who are at low risk for hepatitis B virus reactivation (HBVr).

4. AGA suggests against using anti-hepatitis Bs (HBs) status to guide antiviral prophylaxis for all risk groups.

5. AGA suggests use of antiviral drugs with a high barrier to resistance over lamivudine for prophylaxis in patients undergoing immunosuppressive drug therapy.

6. AGA makes no recommendation for a strategy of HBV DNA monitoring followed by rescue treatment as an alternative to antiviral prophylaxis.

7. AGA recommends antiviral drugs with a high barrier to resistance over lamivudine for established HBVr in patients undergoing immunosuppressive drug therapy.

8. AGA recommends screening for HBV (hepatitis B surface antigen (HBsAg) and anti-HBc, followed by a sensitive HBV DNA test if positive) in patients at moderate or high risk who will undergo immunosuppressive drug therapy.

9. AGA suggests against routinely screening for HBV in patients who will undergo immunosuppressive drug therapy and are at low risk.

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