Hepatitis B Prophylaxis Outcomes in Patients Receiving Immunosuppressive Therapy: A Retrospective Cohort Study

Background: Hepatitis B virus (HBV) reactivation is a critical complication for patients undergoing immunosuppressive therapy. This study aimed to evaluate the clinical outcomes of HBV screening, prophylaxis strategies, and the incidence of reactivation in patients receiving immunosuppressive regimens.Methods: We conducted a retrospective study at Gazi University Faculty of Medicine involving 90 patients with HBV infection who were candidates for immunosuppressive therapy between January 2010 and December 2017. Demographic characteristics, viral serology (HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, and HBV-DNA levels), types of underlying diseases, and antiviral prophylaxis protocols were analyzed. Reactivation was defined based on virological and biochemical parameters during follow-up.Results: The study included 90 patients (mean age 53.57 ± 6.3 years; 46.7% female). The primary indications for immunosuppression were oncological diseases (n=55, 61.1%), followed by rheumatologic disorders (18.9%). Among the oncology subgroup, 31 of 55 patients (56.4%) were HBsAg positive, accounting for 31 of the 49 HBsAg-positive patients in the overall cohort. Of 55 patients with adequate follow-up, HBV reactivation was detected in 5 (9.1%). Significant differences were observed in ALT and AST levels based on HBsAg positivity (p=0.036 and p=0.021, respectively). Among followed patients, no reactivation occurred in the lamivudine group (0/11), while reactivation was observed in tenofovir (2/22), entecavir (1/14), and sequential lamivudine-tenofovir groups (2/8). The highest reactivation rate was observed in patients with delayed prophylaxis initiation.Conclusions: Pre-treatment screening for HBV is essential to identify at-risk patients. Timely initiation of potent antiviral prophylaxis significantly reduces reactivation rates and associated hepatic complications in immunocompromised patients.