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면역억제제 혹은 항암 치료가 필요한 B형간염 환자의 치료

Management of Patients with Hepatitis B Virus Infection Who Receive Immunosuppressive Treatment or Chemotherapy

장정원
대한내과학회 (The Korean Association Of Internal Medicine)|2012.02|대한내과학회지 (The Korean Journal of Medicine)|제82권 제2호|pp. 149-158

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참고문헌

키워드

Chemotherapy항암치료ImmunosuppressionHepatitis B virusB형간염바이러스간부전면역억제Hepatic morbidity
주제분류내과학

초록

의학기술의 발달로 장기이식이 활발해지고, 항암제 및 면역억제제의 효능은 점차 강력해지고 있지만 이에 따라 치료와 관련된 합병증으로 B형간염의 재활성이 문제점으로 나타나게 되었다. 이는 대표적인 종양-면역치료관련 부작용으로 그 임상경과는 환자들의 기저 간질환 등에 따라 다양하게 나타나지만, 적지 않은 환자들에서 항암치료의 연기 및 조기중단을 가져올 수 있기 때문에 치료 전 예방(선제적 항바이러스치료)이 중요하다. 이를 위해 현 임상에서 무엇보다 필요한 것은 항암치료를 담당하고 있는 항암관련 임상의가 치료 중 발생할 수 있는 B형간염바이러스의 재활성을 충분히 인지하고 적절히 대처하는 것이다. 이와 함께 B형 간염 재활성 예방을 위한 적절한 항바이러스 치료대책에 관해 각 임상과간 협진체계를 긴밀히 유지하는 것도 중요한 요소이다. 항암치료 중 발생하는 재활성 간염은 확실한 예방법이 있으므로 이를 적절히 활용한다면 재활성 간염에 의한 환자들의 전체적인 임상경과 악화를 예방할 수 있을 것이다.

Abstract

Reactivation of hepatitis B virus (HBV) has been well documented as a complication in HBV surface antigen (HBsAg) carriers who receive cytotoxic or immunosuppressive therapy. With the recent introduction of newer agents with a high level of immunosuppressive effect, this unfavorable event often occurs in patients with HBsAg-negative and/or occult HBV infection. The first step in HBV reactivation management is the identification of the patients at risk of viral reactivation by testing for HBV serology prior to commencing immunosuppressive treatment or chemotherapy. Multiple publications have consistently indicated the benefit of prophylactic or preemptive antiviral therapy in this setting, and justified such approach before the start of cytotoxic therapy. Unresolved issues concerning such prophylactic approach remain in the situations of HBsAg-negative/anti-HBc-positive or negative status, which presumably consists of a large number of occult HBV infection cases. This topic review will summarize clinical issues related to HBV reactivation, focusing clinical manifestations, risk factors associated with HBV reactivation, and a growing body of evidence supporting preventive antiviral therapy in high-risk patients.

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