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Clinical Review State of the Art Review

Hepatitis B virus persistence and reactivation

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2200 (Published 01 September 2020) Cite this as: BMJ 2020;370:m2200
  1. Yu Shi, attending physician1 2 3,
  2. Min Zheng, professor1 2 3
  1. 1The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
  2. 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
  3. 3National Clinical Research Center for Infectious Diseases, China
  1. Correspondence to M Zheng: minzheng{at}zju.edu.cn

Abstract

Hepatitis B virus (HBV) infection causes chronic hepatitis and has long term complications. Individuals ever infected with HBV are at risk of viral reactivation under certain circumstances. This review summarizes studies on HBV persistence and reactivation with a focus on the definitions and mechanisms. Emphasis is placed on the interplay between HBV replication and host immunity as this interplay determines the patterns of persistence following viral acquisition. Chronic infections exhibit as overt persistence when a defective immune response fails to control the viral replication. The HBV genome persists despite an immune response in the form of covalently closed circular DNA (cccDNA) and integrated DNA, rendering an occult state of viral persistence in individuals whose infection appears to have been resolved. We have described HBV reactivation that occurs because of changes in the virus or the immune system. This review aims to raise the awareness of HBV reactivation and to understand how HBV persists, and discusses the risks of HBV reactivation in a variety of clinical settings.

Footnotes

  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Acknowledgment: We thank Fujie Xu and Hongqun Liu for valuable discussion, and Shereen Ayub for assistance in writing the manuscript. The work was supported by the 13-5 State S&T Projects of China (2018ZX10302-206) and the Natural Science Foundation of China (81871646 and 81870425).

  • Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none.

  • Further details of The BMJ policy on financial interests are here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests

  • Provenance and peer review: commissioned; externally peer reviewed.

  • Contributorship statement and guarantor: Both authors contributed to conceiving the idea, undertaking the literature search, and writing the manuscript. MZ is the guarantor.

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