Surreal illustration depicting the transformation of a healthy liver to an inflamed one due to hepatitis B reactivation.

HBV Reactivation Alert: Are Your Immunosuppressants Putting You at Risk?

Theo Raines in Health & Wellness August 2025 • 4 min read.

"A closer look at how common medications can trigger hepatitis B reactivation and what you can do to stay safe."

For individuals managing chronic conditions such as psoriasis or rheumatoid arthritis, immunosuppressant medications like adalimumab, infliximab, and ustekinumab can offer much-needed relief. These drugs work by suppressing the immune system, reducing inflammation and alleviating symptoms. However, this immune suppression can come with significant risks, including the reactivation of dormant viruses like hepatitis B (HBV).

Hepatitis B reactivation occurs when the hepatitis B virus, which may be lying dormant in the liver, becomes active again. This can lead to liver damage, liver failure, and other serious complications. A recent study highlighted the cases of five patients who experienced HBV reactivation following treatment with these immunosuppressants, raising important questions about patient safety and monitoring.

If you're using immunosuppressants, especially if you have a history of HBV infection, understanding the risks and taking proactive steps is essential. This article breaks down the critical information you need to protect your health, offering insights into who is most at risk, how to identify reactivation, and what preventative measures you can take.

Who's at Risk of HBV Reactivation from Immunosuppressants?

Surreal illustration depicting the transformation of a healthy liver to an inflamed one due to hepatitis B reactivation.

The risk of hepatitis B reactivation is particularly relevant for individuals who have previously been infected with HBV. Even if the infection is no longer active and the virus is dormant, immunosuppressive medications can weaken the immune system's ability to keep the virus suppressed. This allows the virus to replicate and cause renewed liver inflammation and damage.

Several factors can increase your risk:

Past HBV Infection: Individuals with a history of hepatitis B infection, even if the virus is inactive, are at higher risk.
Immunosuppressant Use: Medications like adalimumab, infliximab, ustekinumab, and prednisone can suppress the immune system, increasing the risk of HBV reactivation.
Combination Therapy: Using multiple immunosuppressants simultaneously may further elevate the risk.
Underlying Conditions: Conditions such as psoriasis and rheumatoid arthritis, which require immunosuppressive treatment, indirectly contribute to the risk.

The study mentioned earlier involved five patients who had previously contracted HBV and were being treated for psoriasis or rheumatoid arthritis. These patients developed HBV reactivation within 6 to 18 months after starting immunosuppressive therapy, underscoring the importance of vigilance and monitoring.

Protecting Your Liver: Proactive Steps to Take

If you are taking immunosuppressants, particularly for conditions like psoriasis or rheumatoid arthritis, it's crucial to discuss the risk of hepatitis B reactivation with your healthcare provider. Regular monitoring, antiviral prophylaxis, and lifestyle adjustments can help safeguard your liver health.

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Everything You Need To Know

What is HBV reactivation, and why is it a concern for those on immunosuppressants?

HBV reactivation refers to the reawakening of the hepatitis B virus in individuals who have previously been infected. This is a significant concern, especially for patients undergoing treatment with immunosuppressants like adalimumab, infliximab, and ustekinumab because these medications weaken the immune system. With a suppressed immune system, the dormant HBV can become active again, leading to liver damage, liver failure, and other serious complications. The use of prednisone also elevates this risk. This is why regular monitoring is crucial.

Which immunosuppressants are most commonly associated with HBV reactivation?

Several immunosuppressants have been linked to HBV reactivation. Notably, medications such as adalimumab, infliximab, and ustekinumab have been identified as potential triggers. These drugs are often used to treat conditions like psoriasis and rheumatoid arthritis. Prednisone, too, is mentioned as an immunosuppressant that can elevate the risk. These medications suppress the immune system, making it easier for the hepatitis B virus to reactivate.

Who is most at risk of HBV reactivation when taking immunosuppressants?

Individuals with a history of hepatitis B infection are at the highest risk of HBV reactivation when taking immunosuppressants. Even if the HBV infection was previously inactive, the use of immunosuppressants such as adalimumab, infliximab, or ustekinumab can weaken the immune system's ability to keep the virus suppressed. Other factors that may increase the risk are the usage of multiple immunosuppressants simultaneously and underlying conditions like psoriasis and rheumatoid arthritis, which often necessitate immunosuppressive treatments.

How can I protect myself from HBV reactivation if I am taking immunosuppressants?

If you are taking immunosuppressants, particularly for conditions like psoriasis or rheumatoid arthritis, the best approach involves proactive measures in consultation with your healthcare provider. Regular monitoring for signs of HBV reactivation is crucial. This often involves blood tests to check for the presence of the virus and liver function. Antiviral prophylaxis, which involves taking antiviral medications to prevent HBV reactivation, might also be recommended. Additionally, discuss any lifestyle adjustments that might support liver health.

What was the outcome of the study involving patients with psoriasis or rheumatoid arthritis, and what does it tell us about HBV reactivation?

The study highlighted the cases of five patients who experienced HBV reactivation after starting immunosuppressive therapy with drugs such as adalimumab and infliximab for psoriasis or rheumatoid arthritis. These patients developed HBV reactivation within 6 to 18 months of beginning treatment. This underscores the critical importance of vigilance and monitoring. The study indicates that even with conditions like psoriasis or rheumatoid arthritis that require immunosuppressive treatment, there's a significant risk of HBV reactivation, emphasizing the need for proactive measures to protect liver health.