Shielding against HBV reactivation during immunosuppressant therapy

HBV Reactivation: Are Your Immunosuppressants to Blame?

Soraya Malik in Health & Wellness December 2025 • 3 min read.

"A new study highlights the risk of Hepatitis B virus reactivation in patients undergoing immunosuppressant therapy."

For individuals managing chronic conditions such as psoriasis and rheumatoid arthritis, immunosuppressant medications like adalimumab, infliximab, prednisone, and ustekinumab offer a beacon of hope. These drugs work by suppressing the immune system, reducing inflammation, and alleviating debilitating symptoms. However, this immune suppression can sometimes lead to unintended consequences, such as the reactivation of dormant viruses.

A recent study published in the Turkish Journal of Gastroenterology sheds light on a concerning trend: Hepatitis B virus (HBV) reactivation in patients undergoing immunosuppressant therapy. The study, conducted in December 2017, examined five cases where patients developed HBV reactivation following the administration of these commonly prescribed medications. This raises critical questions about patient safety and the need for vigilant monitoring.

Understanding the link between immunosuppressants and HBV reactivation is crucial for both patients and healthcare providers. This article delves into the findings of the study, explores the underlying mechanisms, and provides practical guidance on how to mitigate the risk of HBV reactivation while effectively managing chronic inflammatory conditions.

The Study: Unveiling the Link Between Immunosuppressants and HBV Reactivation

Shielding against HBV reactivation during immunosuppressant therapy

The study focused on five patients who had a history of HBV infection and were being treated for either psoriasis or rheumatoid arthritis. Among these patients, four had psoriasis, and one had rheumatoid arthritis. The medications they were receiving included:

The study revealed that HBV reactivation occurred between 6 to 18 months after the initiation of immunosuppressant therapy. This timeline suggests a gradual weakening of the immune system's control over the virus, eventually leading to its resurgence.

Adalimumab (3 patients)
Ustekinumab (1 patient)
Infliximab and prednisone 4 mg/day (1 patient)

All patients who experienced HBV reactivation were subsequently treated with entecavir, an antiviral medication used to suppress HBV. However, the study did not provide specific details on the outcomes of this treatment, highlighting the need for further research in this area.

Staying Informed and Proactive About HBV Reactivation

The possibility of HBV reactivation during immunosuppressant therapy may be unnerving, but it is critical to remain proactive and well-informed. Consistent communication with healthcare providers, routine monitoring, and immediate management of any concerning symptoms are necessary. You can properly manage your chronic illness while minimizing the risk of HBV reactivation with constant attention. As research develops and medical procedures advance, people will be able to live longer, healthier lives while receiving the care they require.

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Everything You Need To Know

What does Hepatitis B virus reactivation mean?

Hepatitis B virus reactivation refers to the resurgence of the Hepatitis B virus in individuals who were previously infected, even if the virus was dormant or inactive. This can occur when the immune system, which normally keeps the virus in check, is weakened. Reactivation is significant because it can lead to liver damage, hepatitis, and other serious health complications. The study indicates individuals using immunosuppressants such as adalimumab, infliximab, ustekinumab and prednisone, may be at higher risk.

How do immunosuppressant medications trigger Hepatitis B virus reactivation?

Immunosuppressant medications, such as adalimumab, infliximab, prednisone, and ustekinumab, are used to suppress the immune system, which helps to reduce inflammation and alleviate symptoms in conditions like psoriasis and rheumatoid arthritis. However, by weakening the immune system, these medications can impair the body's ability to control the Hepatitis B virus, potentially leading to HBV reactivation. The trade-off is managing the chronic condition versus the risk of viral reactivation.

How long after starting immunosuppressants can Hepatitis B virus reactivation occur?

The study showed that Hepatitis B virus reactivation can occur between 6 to 18 months after starting immunosuppressant therapy like adalimumab, infliximab, prednisone, and ustekinumab. This timeframe suggests that the immune system's control over the virus gradually weakens over time, eventually leading to its resurgence. It's important to note that this timeline might vary from person to person, emphasizing the need for regular monitoring.

What is entecavir and how is it used in the context of Hepatitis B virus reactivation?

Entecavir is an antiviral medication used to suppress Hepatitis B virus. In the study, all patients who experienced Hepatitis B virus reactivation were treated with entecavir. The study does not include the outcomes of entecavir treatment. Further research is needed to fully understand the effectiveness of entecavir in these situations. Other antiviral medications may also be used, depending on the specific case.

What steps can I take to stay safe while on immunosuppressants?

If you are taking immunosuppressants like adalimumab, infliximab, prednisone, and ustekinumab it is crucial to have open communication with your healthcare provider, undergo routine monitoring for Hepatitis B virus reactivation, and promptly report any concerning symptoms. Regular blood tests can help detect early signs of reactivation, allowing for timely intervention and management. Proactive management involves balancing the benefits of immunosuppressant therapy with the risk of Hepatitis B virus reactivation.