HBV reactivation (HBVr) can occur due to the ability of HBV to remain latent in the liver\nas covalently closed circular DNA and by the capacity of HBV to alter the immune system of the\ninfected individuals. HBVr can occur in patients undergoing hematopoietic stem cell\ntransplantation (HSCT) with a clinical spectrum that ranges from asymptomatic infection to\nfulminant hepatic failure. The risk of HBVr is determined by a complex interplay between host\nimmunity, virus factors, and immunosuppression related to HSCT. All individuals who undergo\nHSCT should be screened for HBV. HSCT patients positive for HBsAg and also those HBcAbpositive/\nHBsAg-negative are at high risk of HBV reactivation (HBVr) due to profound and\nprolonged immunosuppression. Antiviral prophylaxis prevents HBVr, decreases HBVr-related\nmorbidity and mortality in patients with chronic or previous HBV. The optimal duration of antiviral\nprophylaxis remains to be elucidated. The vaccination of HBV-naïve recipients and their donors\nagainst HBV prior to HSCT has an important role in the prevention of acquired HBV infection. This\nnarrative review provides a comprehensive update on the current concepts, risk factors, molecular\nmechanisms, prevention, and management of HBVr in HSCT.
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