Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 14, 2013; 19(6): 923-930
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.923
Testing for hepatitis B infection in prospective chemotherapy patients: A retrospective study
Ying Wang, Xin-Mei Luo, Dan Yang, Jie Zhang, Hong-Yu Zhuo, Jian Zhang, Yu Jiang
Ying Wang, Xin-Mei Luo, Dan Yang, Jie Zhang, Hong-Yu Zhuo, Jian Zhang, Yu Jiang, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang Y and Luo XM performed the majority of this study and contributed equally to this work; Yang D, Zhang J, Zhuo HY and Zhang J collected vital clinical data and were involved in revising the manuscript; Wang Y, Luo XM and Jiang Y wrote the manuscript; and Jiang Y designed the study and provided financial support for this work.
Supported by The National Natural Science Foundation of China, No. 30801373
Correspondence to: Yu Jiang, MD, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. jiangyu1973@hotmail.com
Telephone: +86-28-85422683 Fax: +86-28-85423278
Received: August 8, 2012
Revised: November 21, 2012
Accepted: December 5, 2012
Published online: February 14, 2013
Abstract

AIM: To estimate hepatitis B virus (HBV) infection testing rate in cancer patients before chemotherapy with a focus on HBV reactivation.

METHODS: A retrospective study was conducted from January 1, 2009 to June 30, 2010. Inclusion required that patients be naïve to cancer chemotherapy but have indications for it. Patients who did not receive chemotherapy for any reason were excluded. Important clinical information, such as the levels of HBV DNA and serological markers were collected. HBV reactivation was defined as an increase in serum HBV DNA to > 1 log higher than that of the pre-exacerbation baseline, or serum HBV DNA conversion from negative to positive. HBV DNA levels > 1000 copies/mL were defined as HBV DNA positive. The χ2 or Fisher’s exact test was used for analysis of categorized data. Multiple logistic regression analysis was used to estimate the odd ratio and 95%CI of the HBV screening rate.

RESULTS: Of 6646 patients, 5616 (84.5%) received chemotherapy. Only 17.1% of the cancer patients received pre-chemotherapy HBV testing (43.2% for hematological malignancies and 14.9% for solid tumors). Patients who had received rituximab therapy, had elevated aminotransferase levels, or had hematological malignancies were more likely to receive HBV testing. The prevalence of hepatitis B surface antigen (HBsAg) positivity was 13.4%. HBV reactivation (appearance of HBV DNA or an increase in HBV DNA levels by 1 log10) was observed in 33.1% (53/160) of the patients after chemotherapy. Among patients without prophylactic antiviral therapy, the reactivation rate was 43.9% (43/98) in the solid tumor group. Two reactivation cases occurred in patients who were HBsAg negative, but positive for hepatitis B core antibody. HBV reactivation was more likely to occur in patients with lymphoma, high levels of HBV DNA, or hepatitis B e antigen, and in men.

CONCLUSION: Less than 20% of patients received HBV testing before chemotherapy. HBV reactivation would have occurred in about 50% of infected patients with solid tumors without antiviral prophylaxis.

Keywords: Chemotherapy, Hematologic malignancy, Hepatitis B virus, Hepatitis B virus reactivation, Solid tumor