Brief Article
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World J Gastroenterol. Nov 21, 2010; 16(43): 5447-5451
Published online Nov 21, 2010. doi: 10.3748/wjg.v16.i43.5447
Entecavir as treatment for reactivation of hepatitis B in immunosuppressed patients
Sylvia Brost, Paul Schnitzler, Wolfgang Stremmel, Christoph Eisenbach
Sylvia Brost, Wolfgang Stremmel, Christoph Eisenbach, Department of Gastroenterology and Infectious Diseases, University of Heidelberg, 69120 Heidelberg, Germany
Paul Schnitzler, Department of Infectious Diseases, Virology, University of Heidelberg, 69120 Heidelberg, Germany
Author contributions: Brost S was involved in the conception of the study, collected and interpreted clinical data, and helped to draft the manuscript; Schnitzler P made the blood samples available, carried out all virological tests and revised the manuscript; Stremmel W was involved in the conception of the study and revised it critically; Eisenbach C designed and coordinated the study, and drafted the manuscript; all authors read and approved the final manuscript.
Correspondence to: Dr. Christoph Eisenbach, PD, Department of Gastroenterology and Infectious Diseases, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. christoph_eisenbach@med.uni-heidelberg.de
Telephone: +49-6221-568825 Fax: +49-6221-566858
Received: June 17, 2010
Revised: July 24, 2010
Accepted: July 31, 2010
Published online: November 21, 2010
Abstract

AIM: To study the efficacy and safety of entecavir (ETV) as first-line therapy for hepatitis B virus (HBV) reactivation due to immunosuppression.

METHODS: Four patients that were treated with different immunosuppressive regimens for hematological malignancies, who presented with HBV reactivation were treated with ETV. Clinical outcome, biochemical and virological factors, including quantitative hepatitis B surface antigen (HBsAg) were studied.

RESULTS: In all patients, ETV induced suppression of HBV, and rapid clinical improvement without side effects. In one patient with an alanine aminotransferase (ALT) flare, tenofovir was added after 3 mo of treatment. Until death from disease progression at 6 mo after treatment initiation, this patient did not clear HBV infection. Retrospectively, it is highly probable that the patient had been non-adherent. In the other three patients, the virological responses were associated with an expeditious decrease in quantitative HBsAg titers with negativity after 2 mo, and all three had HBsAg seroconversion. In one patient, HBV DNA reached a plateau after 3 mo, before becoming undetectable after 1 year, despite early ALT normalization and undetectable quantitative HBsAg.

CONCLUSION: ETV seems to be effective and safe treatment for HBV reactivation. Monitoring of quantitative HBsAg might be an additional useful tool to monitor treatment response.

Keywords: Hepatitis B virus, Entecavir, Immunosuppression, Hepatitis B surface antigen, Seroconversion