Risk of reactivation of Hepatitis B with corticosteroids

In a retrospective territory-wide study from Hong Kong patients
who were negative for Hepatitis B surface antigen (HBsAg)
who received corticosteroids were evaluated for the risk
of seroreversion. Among 12,997 patients, 970 were anti-HBc
positive only, 830 were positive for both anti-HBs and anti-
HBc and 10,561 were only anti-HBs positive. The remaining
patients were negative for both anti-HBs and anti-HBc. The
rate of liver failure was low and similar in previously hepatits B
exposed and unexposed (1.1 % vs 0.9 %). 165 patients had HBsAg
seroreversion with the highest risk in those who were only
anti-HBc positive (1.8 % after one year and 5.5 % after 10 years).
The risk of flare (ALT > x2 upper limit of normal) was however
not linked to seroreversion and was not higher in previously
hepatitis B exposed compared to non-exposed. Higher doses
of corticosteroids (20-40 mg of prednisolone or higher) were
associated with increased risk of flare.

Ref; Wong et al. J Hepatol 2019; doi: 10.1016/j.jhep.2019.08.023

Comment: Do we need to give prophylactic antiviral treatment
to patients who are treated with corticosteroids and who have
been previously exposed to hepatitis B? The present results do
not suggest that this is always necessary. Even though the risk
of seroreversion was increased it was not associated with increased
risk of hepatic flare or hepatic failure.