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Chang ML, Liaw YF. Hepatitis B Flare in Hepatitis B e Antigen-Negative Patients: A Complicated Cascade of Innate and Adaptive Immune Responses. Int J Mol Sci 2022; 23:ijms23031552. [PMID: 35163476 PMCID: PMC8836007 DOI: 10.3390/ijms23031552] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is a dynamic process involving interactions among HBV, hepatocytes, and the host immune system. The natural course of chronic hepatitis B (CHB) is divided into four chronological phases, including the hepatitis B e antigen (HBeAg)-positive and HBeAg-negative phases. During HBV flare, alanine aminotransferase (ALT) levels abruptly rise to >5× the upper limit of normal; this is thought to occur due to the immune response against an upsurge in serum HBV DNA and antigen levels. Hepatitis flares may occur spontaneously, during or after antiviral therapy, or upon immunosuppression or chemotherapy in both HBeAg-positive and HBeAg-negative patients. The clinical spectrum of HBV flares varies from asymptomatic to hepatic decompensation or failure. HBeAg seroconversion with ≥ 1 year of consolidation therapy is accepted as an endpoint of oral antiviral therapy in HBeAg-positive patients, but recommendations for treating HBeAg-negative patients differ. Thus, the management of HBeAg-negative patients has attracted increasing interest. In the current review, we summarize various types of HBV flares and the associated complex cascade of innate and adaptive immune responses, with a focus on HBeAg-negative CHB patients. Hopefully, this review will provide insight into immunopathogenesis to improve the management of HBV flares in HBeAg-negative CHB patients.
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Affiliation(s)
- Ming-Ling Chang
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan;
- Division of Hepatology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8107); Fax: +886-3-3272236
| | - Yun-Fan Liaw
- College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan;
- Division of Hepatology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
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Chen MH, Lee IC, Chen MH, Hou MC, Tsai CY, Huang YH. Abatacept is second to rituximab at risk of HBsAg reverse seroconversion in patients with rheumatic disease. Ann Rheum Dis 2021; 80:1393-1399. [PMID: 34187776 DOI: 10.1136/annrheumdis-2021-220774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B surface antigen (HBsAg) reverse seroconversion (RS) can happen in patients with rheumatoid arthritis (RA) with resolved hepatitis B (RHB) undergoing biological disease-modifying antirheumatic drugs (bDMARDs). But the incidence and risk factors need to be delineated. METHODS From 2003 to 2019, 1937 patients with RA with available HBsAg and antibody to hepatitis B virus (HBV) core antigen data were retrospectively reviewed, and 489 patients with RHB undergoing bDMARDs treatment were identified. Factors associated with HBsAg RS were analysed. RESULTS During 67 828 person-months of follow-up, 27 (5.5%) patients developed HBsAg RS after bDMARD treatment. As compared with those without HBsAg RS, patients with HBsAg RS were older, had lower frequency of antibody to HBsAg (anti-HBs), and lower baseline anti-HBs levels. In multivariate analysis, rituximab, abatacept and baseline negative for anti-HBs were the independent risk factors for HBsAg RS (adjusted HR: 87.76, 95% CI: 11.50 to 669.73, p<0.001; adjusted HR: 60.57, 95% CI: 6.99 to 525.15, p<0.001; adjusted HR: 5.15, 95% CI: 2.21 to 12.02, p<0.001, respectively). The risk of HBsAg RS was inversely related to the level of anti-HBs. Both rituximab and abatacept might result in anti-HBs loss, and abatacept had a cumulative incidence of HBsAg RS of 35.4%-62.5% in patients with low titers or negative of anti-HBs. CONCLUSIONS Not only rituximab, but also abatacept has a high risk of HBV reactivation in patient with RA with RHB. Anti-HBs positivity cannot confer HBV reactivation-free status if the anti-HBs levels are not high enough for patients with RHB on rituximab and abatacept treatment.
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Affiliation(s)
- Ming-Han Chen
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Cheng Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Huang Chen
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Dooghaie Moghadam A, Eslami P, Dowlati Beirami A, Iravani S, Farokhi E, Mansour-Ghanaei A, Hashemi MR, Aghajanpoor Pasha M, Mehrvar A, Nassiri-Toosi M. An Overview of the Current Hepatitis B Treatment Strategies after Liver Transplantation. Middle East J Dig Dis 2021; 13:5-14. [PMID: 34712432 PMCID: PMC8531931 DOI: 10.34172/mejdd.2021.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022] Open
Abstract
Currently, liver transplantation (LT) is considered as the only option for the treatment of patients with various causes of liver failure, including patients with chronic hepatitis B virus (HBV) infections. Overall, patients with HBV who undergo LT are at increased risk of hepatitis B infection recurrence. Although the current knowledge regarding the pathophysiology of this infection has been dramatically increased over the past few decades, it is still considered a complex disease process with varying degrees of clinical characteristics and changing patterns over time. There are various treatment strategies for preventing HBV recurrence in the LT setting. Generally, these regimens include oral nucleoside/ nucleotide analogues (NAs), hepatitis B immune globulin (HBIG), and vaccines or the combination of these drugs. The treatment strategy of choice should be based on cost-effectiveness, along with other patients underlying conditions. In this case, studies indicate that potent NAs are more cost-effective than HBIG in most case scenarios. In this article, we aimed to review the general medications used in the prophylaxis of the recurrence of HBV infection after LT.
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Affiliation(s)
- Arash Dooghaie Moghadam
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Eslami
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Dowlati Beirami
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrokh Iravani
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran
| | - Ermia Farokhi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Guilan, Iran
| | - Mahmood Reza Hashemi
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Morteza Aghajanpoor Pasha
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran
| | - Mohssen Nassiri-Toosi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Chen MH, Chen MH, Chou CT, Hou MC, Tsai CY, Huang YH. Low but Long-lasting Risk of Reversal of Seroconversion in Patients With Rheumatoid Arthritis Receiving Immunosuppressive Therapy. Clin Gastroenterol Hepatol 2020; 18:2573-2581.e1. [PMID: 32205219 DOI: 10.1016/j.cgh.2020.03.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In patients who have resolved hepatitis B virus (HBV) infection, treatment of rheumatoid arthritis (RA) can result in reappearance of hepatitis B surface antigen (HBsAg), called reverse seroconversion. We investigated clinical features and outcomes of reverse seroconversion in patients who received immunosuppressant or biologic therapy for RA. METHODS We identified 1494 patients with RA (925 who resolved HBV infection) and available data on levels of antibody to HB core antigen and HBsAg who had attended Taipei Veterans General Hospital from January 2007 through December 2017. We identified 17 cases (median age, 66 years) who were negative for HBsAg before treatment of RA and reverse seroconversion (HBsAg reappearance) after glucocorticoid treatment (n = 13) and/or biologic therapy (adalimumab, n = 2; etanercept, n = 1; rituximab, n = 9; or abatacept, n = 4). Four patients were positive for antibodies against HBsAg (seroconverted) before the immunosuppressive treatment. RESULTS The median time from immunosuppressive treatment to reverse seroconversion was 120 months (range, 20-264 months), whereas the time from biologic therapy treatment to reverse seroconversion was 66 months (range, 10-105 months). After reverse seroconversion, 8 individuals (47.1%) were positive for HB e antigen; 9 cases (52.9%) did not have a flare of alanine transaminase. However, 3 patients (17.6%) developed liver decompensation. CONCLUSIONS In patients who resolved HBV infection and received immunosuppressant treatment of RA, risk of reversal of seroconversion is low but persists for up to 10 years. Patients with RA who previously resolved HBV infections should be monitored for levels of HBsAg and HBV DNA once immunosuppressive treatment of RA begins.
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Affiliation(s)
- Ming-Han Chen
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; Faculty of Medicine
| | | | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; Faculty of Medicine
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; Faculty of Medicine.
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei.
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Bessone F, Dirchwolf M. Management of hepatitis B reactivation in immunosuppressed patients: An update on current recommendations. World J Hepatol 2016; 8:385-394. [PMID: 27004086 PMCID: PMC4794528 DOI: 10.4254/wjh.v8.i8.385] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 01/15/2016] [Accepted: 03/07/2016] [Indexed: 02/06/2023] Open
Abstract
The proportion of hepatitis B virus (HBV) previously exposed patients who receive immunosuppressive treatment is usually very small. However, if these individuals are exposed to potent immunosuppressive compounds, the risk of HBV reactivation (HBVr) increases with the presence of hepatitis B surface antigen (HBsAg) in the serum. Chronic HBsAg carriers have a higher risk than those who have a total IgG anticore as the only marker of resolved/occult HBV disease. The loss of immune control in these patients may results in the reactivation of HBV replication within hepatocytes. Upon reconstitution of the immune system, infected hepatocytes are once again targeted and damaged by immune surveillance in an effort to clear the virus. There are different virological scenarios, and a wide spectrum of associated drugs with specific and stratified risk for the development of HBVr. Some of this agents can trigger a severe degree of hepatocellular damage, including hepatitis, acute liver failure, and even death despite employment of effective antiviral therapies. Currently, HBVr incidence seems to be increasing around the world; a fact mainly related to the incessant appearance of more powerful immunosuppressive drugs launched to the market. Moreover, there is no consensus on the length of prophylactic treatment before the patients are treated with immunosuppressive therapy, and for how long this therapy should be extended once treatment is completed. Therefore, this review article will focus on when to treat, when to monitor, what patients should receive HBV therapy, and what drugs should be selected for each scenario. Lastly, we will update the definition, risk factors, screening, and treatment recommendations based on both current and different HBV management guidelines.
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Affiliation(s)
- Fernando Bessone
- Fernando Bessone, Department of Gastroenterology and Hepatology, School of Medicine, University of Rosario, Rosario 2000, Argentina
| | - Melisa Dirchwolf
- Fernando Bessone, Department of Gastroenterology and Hepatology, School of Medicine, University of Rosario, Rosario 2000, Argentina
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Yoo JJ, Cho EJ, Cho YY, Lee M, Lee DH, Cho Y, Lee JH, Yu SJ, Yoon SS, Yoon JH, Kim YJ. Efficacy of antiviral prophylaxis in HBsAg-negative, anti-HBc positive patients undergoing hematopoietic stem cell transplantation. Liver Int 2015; 35:2530-6. [PMID: 26053357 DOI: 10.1111/liv.12882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/25/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Hepatitis B virus (HBV) reactivation can occur in persons who are hepatitis B surface antigen (HBsAg)-negative but hepatitis B core antibody (anti-HBc) positive, especially following hematopoietic stem cell transplantation (HSCT). However, evidence supporting the routine use of prophylactic antiviral agents for such patients is scarce. The aim of this study was to compare the frequency of HBV reactivation between prophylactic and non-prophylactic groups in patients who underwent HSCT. METHODS This retrospective cohort study included 315 HBsAg-negative, anti-HBc positive patients who received autologous or allogenic stem cell transplantation from January 2008 to December 2013. Patients were categorized into prophylactic and non-prophylactic groups. The primary endpoint was the incidence of HBV reactivation. RESULTS Median follow-up duration was 21.4 months. Antiviral prophylaxis was not given to 219 patients, and 96 received prophylaxis. The median duration of prophylaxis was 7.0 months. HBV reactivated in 12 patients (prophylactic group, 4; non-prophylactic group, 8). The median time to reactivation was 20.5 months after starting chemotherapy. All patients who reactivated were promptly and successfully treated with rescue antiviral agents. The risk of reactivation did not differ between prophylactic and non-prophylactic groups (P = 0.061) but was increased significantly by the allogenic type of HSCT and the loss of recipient's antibodies against HBsAg (anti-HBs). CONCLUSIONS Short-term antiviral prophylaxis appears insufficient to decrease the risk of HBV reactivation. Therefore, either prophylaxis longer than 24 months or careful monitoring of HBV DNA combined with on-demand antiviral treatment may prove more effective than the routine short-term prophylaxis given to these patients.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Youn Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Minjong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yuri Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Mozessohn L, Chan KKW, Feld JJ, Hicks LK. Hepatitis B reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab for lymphoma: a meta-analysis. J Viral Hepat 2015; 22:842-9. [PMID: 25765930 DOI: 10.1111/jvh.12402] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/11/2015] [Indexed: 12/18/2022]
Abstract
Patients with chronic hepatitis B (HBsAg-positive) are at risk of viral reactivation if rituximab is administered without antiviral treatment, a potentially fatal complication of treatment. Patients with so-called 'resolved hepatitis B virus infection' (HBsAg-negative/cAb-positive) may also be at risk. We performed a systematic review of the English and Chinese language literature to estimate the risk of hepatitis B virus (HBV) reactivation in HBsAg-negative/cAb-positive patients receiving rituximab for lymphoma. A pooled risk estimate was calculated for HBV reactivation. The impact of HBsAb status and study design on reactivation rates was explored. Data from 578 patients in 15 studies were included. 'Clinical HBV reactivation', (ALT >3 × normal and either an increase in HBV DNA from baseline or HBsAg seroreversion), was estimated at 6.3% (I(2) = 63%, P = 0.006). Significant heterogeneity was detected. Reactivation rates were higher in prospective vs retrospective studies (14.2% vs 3.8%; OR = 4.39, 95% CI 0.83-23.28). Exploratory analyses found no effect of HBsAb status on reactivation risk (OR = 0.083; P = 0.151). Our meta-analysis confirms a measurable and potentially substantial risk of HBV reactivation in HBsAg-negative/cAb-positive patients exposed to rituximab. However, heterogeneity in the existing literature limits the generalizability of our findings. Large, prospective studies, with uniform definitions of HBV reactivation, are needed to clarify the risk of HBV reactivation in HBsAg-negative/cAb-positive patients.
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Affiliation(s)
- L Mozessohn
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada
| | - K K W Chan
- Division of Hematology/Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - J J Feld
- Toronto Centre for Liver Disease, Toronto Western Hospital Liver Centre, Toronto, ON, Canada
| | - L K Hicks
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada
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Wu CY, Hsiao LT, Chiou TJ, Gau JP, Liu JH, Yu YB, Wu YT, Liu CJ, Huang YC, Hung MH, Chen PM, Huang YH, Tzeng CH. Lymphocyte/monocyte ratio and cycles of rituximab-containing therapy are risk factors for hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma and resolved hepatitis B. Leuk Lymphoma 2015; 56:2357-64. [PMID: 25459444 DOI: 10.3109/10428194.2014.991922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reactivation of hepatitis B virus (HBV) following rituximab (R)-containing chemotherapy for lymphoma is a major concern, and risk factors remain to be defined. We enrolled 190 patients diagnosed with diffuse large B-cell lymphoma (DLBCL) and resolved hepatitis B, receiving first-line R-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone)-based regimens. Twenty-seven patients (14.2%) developed HBV reactivation during a median follow-up of 23.6 months. Two independent risk factors were identified: cycles of rituximab>8 (hazard ratio [HR], 2.797; 95% confidence interval [CI], 1.184-6.612) and lymphocyte/monocyte ratio (LMR)<2.50 (HR, 2.733; 95% CI, 1.122-6.657). Two-year overall survival in patients with or without HBV reactivation was 53.8% vs. 77.6% (p=0.025). Regarding the negative impact on clinical outcome, patients at "super high risk" of HBV reactivation, including those receiving more than eight cycles of R and having low LMR at diagnosis, may warrant first priority for antiviral prophylaxis.
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Affiliation(s)
- Chia-Yun Wu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Liang-Tsai Hsiao
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Tzeon-Jye Chiou
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,c Division of Transfusion Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Jyh-Pyng Gau
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Jin-Hwang Liu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yuan-Bin Yu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yi-Tsui Wu
- d Department of Nursing , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Chia-Jen Liu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yu-Chung Huang
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,e Division of Hematology and Medical Oncology, Department of Medicine , Taipei Veterans General Hospital , Taoyuan Branch, Taoyuan , Taiwan
| | - Man-Hsin Hung
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Po-Min Chen
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yi-Hsiang Huang
- b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,f Division of Gastroenterology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Cheng-Hwai Tzeng
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
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9
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Morisco F, Guarino M, La Bella S, Di Costanzo L, Caporaso N, Ayala F, Balato N. Lack of evidence of viral reactivation in HBsAg-negative HBcAb-positive and HCV patients undergoing immunosuppressive therapy for psoriasis. BMC Gastroenterol 2014; 14:214. [PMID: 25523080 PMCID: PMC4279461 DOI: 10.1186/s12876-014-0214-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/09/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND HBV and HCV reactivation have been widely reported in patients undergoing immunosuppressive therapy (IT); however, few data are available on the risk of reactivation in patients with psoriasis receiving IT. The aim of our study was to assess the prevalence of HBV and HCV infection in patients with psoriasis and to evaluate the effects of IT during the course of the infection. METHODS The study included psoriatic patients who attended an Italian tertiary referral hospital from 2009 to 2012. A total of 224 patients were enrolled. We evaluated: HBV and HCV markers, type of IT and the occurrence of viral reactivation. The observational period ranged from the beginning of IT to the last visit, with a mean follow-up period of 54 months. RESULTS Two hundred and twenty patients (135 males and 89 females; mean age 59 years; range 18-86 years) with psoriasis, with or without psoriatic arthritis, receiving conventional IT and/or biological drugs were tested for markers of infection. We identified 23/224 patients (10.2%) with isolated positivity for HBcAb positivity, 36/224 (16%) with positivity for HBsAb/HBcAb, and 15/224 (6.6%) with positivity for HCV-Ab. No patient was HBsAg positive, none of them underwent pre-emptive therapy with lamivudine or other antiviral drugs and no one showed episodes of viral reactivation. CONCLUSIONS The prevalence of HBsAg in patients with psoriasis is lower than that observed in the general population. The prevalence of isolated positivity for HBcAb and of combined positivity for HBcAb and HBsAb is 10.2% and 16%, respectively. The prevalence of HCV infection (HCV-RNA+) is 4%. In patients with psoriasis and HCV-Ab or HBcAb positivity, the IT seems to be safe, regardless of the type of drugs.
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Affiliation(s)
- Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Serena La Bella
- Dermatology Units, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Luisa Di Costanzo
- Dermatology Units, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Nicola Caporaso
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Fabio Ayala
- Dermatology Units, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
| | - Nicola Balato
- Dermatology Units, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
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Liu WP, Zheng W, Song YQ, Ping LY, Wang GQ, Zhu J. Hepatitis B surface antigen seroconversion after HBV reactivation in non-Hodgkin’s lymphoma. World J Gastroenterol 2014; 20:5165-5170. [PMID: 24803836 PMCID: PMC4009558 DOI: 10.3748/wjg.v20.i17.5165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/18/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Reactivation of hepatitis B virus (HBV) can occur in lymphoma patients infected with HBV when they receive chemotherapy or immunotherapy. Prophylactic administration of lamivudine (LAM) reduces the morbidity and mortality associated with HBV reactivation. However, what defines HBV reactivation and the optimal duration of treatment with LAM have not yet been clearly established. HBV reactivation may occur due to the cessation of prophylactic LAM, although re-treatment with nucleoside analogs may sometimes result in hepatitis B surface antigen (HBsAg) seroconversion, which is a satisfactory endpoint for the management of HBV infection. We report a case of HBV reactivation in a 68-year-old HBsAg-positive patient who received rituximab-based immunochemotherapy for follicular lymphoma. HBV reactivation developed following cessation of prophylactic LAM therapy. The patient subsequently received treatment with entecavir (ETV), which led to a rapid and sustained suppression of HBV replication and HBsAg seroconversion. We also appraised the literature concerning HBV reactivation and the role of ETV in the management of HBV reactivation in lymphoma patients. A total of 28 cases of HBV reactivation have been reported as having been treated with ETV during or after immunosuppressive chemotherapy in lymphoma patients. We conclude that ETV is an efficacious and safe treatment for HBV reactivation following LAM cessation in lymphoma patients treated with rituximab-based immunochemotherapy.
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Xuan D, Yu Y, Shao L, Wang J, Zhang W, Zou H. Hepatitis reactivation in patients with rheumatic diseases after immunosuppressive therapy--a report of long-term follow-up of serial cases and literature review. Clin Rheumatol 2013; 33:577-86. [PMID: 24343455 PMCID: PMC3962582 DOI: 10.1007/s10067-013-2450-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/24/2013] [Indexed: 12/16/2022]
Abstract
The aims of this paper are to report hepatitis B virus reactivation in 12 patients with rheumatic disease undergoing immunosuppressive therapy and to evaluate whether pre-emptive antiviral therapy is necessary in patients receiving disease-modifying anti-rheumatic drugs. From January 2008 to March 2012, a total of 12 HBV-infected patients with rheumatic diseases were consecutively enrolled in the long-term follow-up. Liver function, HBV DNA, and serum aminotransferase level were tested during the follow-up. We also reviewed the published reports and summarized the clinical characteristics of HBV reactivation during immunosuppressive therapy in patients with rheumatic diseases. The medium duration of follow-up was 41 months (range 16–48). Patients were treated with prednisone, disease-modifying anti-rheumatic drugs (DMARDs) or tumor necrosis factor-alpha-blocking agents (TNFBA). HBV reactivation was only documented in two patients treated with prednisone without pre-emptive antiviral therapy. One hundred patients from literature review were identified as having HBV reactivation; 20.8 % of the patients receiving prednisone experienced HBV reactivation compared to only 4.46 and 9.52 % of patients treated with DMARDs or TNFBA, respectively. This long-term follow-up of serial cases suggests that pre-emptive antiviral therapy should be administered in patients receiving prednisone therapy for rheumatic disease. In contrast, DMARDs and TNFBA are relatively safe to HBV-infected patients with rheumatic diseases. Close monitoring of HBV DNA and ALT levels is necessary in the management of HBV reactivation.
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Affiliation(s)
- Dandan Xuan
- Department of Rheumatology, Huashan Hospital affiliated to Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, China
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Shinkai N, Matsuura K, Sugauchi F, Watanabe T, Murakami S, Iio E, Ogawa S, Nojiri S, Joh T, Tanaka Y. Application of a newly developed high-sensitivity HBsAg chemiluminescent enzyme immunoassay for hepatitis B patients with HBsAg seroclearance. J Clin Microbiol 2013; 51:3484-3491. [PMID: 23946517 PMCID: PMC3889723 DOI: 10.1128/jcm.00726-13] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 08/06/2013] [Indexed: 02/07/2023] Open
Abstract
We modified and automated a highly sensitive chemiluminescent enzyme immunoassay (CLEIA) for surface antigen (HBsAg) detection using a combination of monoclonal antibodies, each for a specific epitope of HBsAg, and by improving an earlier conjugation technique. Of 471 hepatitis B virus (HBV) carriers seen in our hospital between 2009 and 2012, 26 were HBsAg seronegative as determined by the Abbott Architect assay. The Lumipulse HBsAg-HQ assay was used to recheck those 26 patients who demonstrated seroclearance by the Abbott Architect assay. The performance of the Lumipulse HBsAg-HQ assay was compared with that of a quantitative HBsAg detection system (Abbott Architect) and the Roche Cobas TaqMan HBV DNA assay (CTM) (lower limit of detection, 2.1 log copies/ml) using blood serum samples from patients who were determined to be HBsAg seronegative by the Abbott Architect assay. Ten patients had spontaneous HBsAg loss. Of 8 patients treated with nucleotide analogues (NAs), two were HBsAg seronegative after stopping lamivudine therapy and 6 were HBsAg seronegative during entecavir therapy. Eight acute hepatitis B (AH) patients became HBsAg seronegative. Of the 26 patients, 16 were HBsAg positive by the Lumipulse HBsAg-HQ assay but negative by the Abbott Architect assay. The differences between the two assays in terms of detectable HBsAg persisted over the long term in the spontaneous loss group (median, 10 months), the NA-treated group (2.5 months), and the AH group (0.5 months). In 9 patients, the Lumipulse HBsAg-HQ assay detected HBsAg when HBV DNA was negative by the CTM assay. HBsAg was also detected by the Lumipulse HBsAg-HQ assay in 4 patients with an anti-HBs concentration of >10 mIU/ml, 3 of whom had no HBsAg escape mutations. The automatic, highly sensitive HBsAg CLEIA Lumipulse HBsAg-HQ is a convenient and precise assay for HBV monitoring.
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Affiliation(s)
- Noboru Shinkai
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kentaro Matsuura
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Fuminaka Sugauchi
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsunamasa Watanabe
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuko Murakami
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Etsuko Iio
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shintaro Ogawa
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunsuke Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Matsui T, Kang JH, Nojima M, Tomonari A, Aoki H, Yamazaki H, Yane K, Tsuji K, Andoh S, Andoh S, Sakai H, Maemori M, Maguchi H, Tanaka Y. Reactivation of hepatitis B virus in patients with undetectable HBsAg undergoing chemotherapy for malignant lymphoma or multiple myeloma. J Med Virol 2013; 85:1900-1906. [PMID: 23926082 DOI: 10.1002/jmv.23694] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 12/16/2022]
Abstract
Despite increasing reports of hepatitis B virus (HBV) reactivation in hematological malignancies, its incidence, and risk factors are still obscure. The aim of this study was to clarify the frequency and risk factors of HBV reactivation in hepatitis B surface antigen (HBsAg) undetectable patients with malignant lymphoma or multiple myeloma, during or after chemotherapy. A total of 109 patients with undetectable HBsAg undergoing chemotherapy for malignant lymphoma or multiple myeloma were enrolled in this study. Anti-hepatitis B surface (anti-HBs) and anti-hepatitis B core (anti-HBc) were checked before treatment, and HBV DNA in sera was quantified monthly during and after chemotherapy. Out of 109 patients, 42 (38.5%) had anti-HBs and 59 (54.1%) had anti-HBc. Among the 59 anti-HBc positive patients, four patients (4/59, 6.8%) showed HBV reactivation during 20.5 median follow-up months. In all four patients with HBV reactivation, peripheral lymphocyte counts before chemotherapy were lower than those without HBV reactivation (P=0.033). HBV reactivation occurred during and after chemotherapy containing rituximab for non-Hodgkin lymphoma. Four patients, who had HBV reactivation, did not develop de novo hepatitis due to HBV reactivation and were able to undergo chemotherapy against malignant lymphoma as scheduled. Monitoring of HBV DNA in sera is useful for the early diagnosis of HBV reactivation, and preemptive therapy is an useful alternative to prevent hepatitis due to HBV reactivation. Patients must be monitored periodically for HBV-DNA levels during and after chemotherapy.
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Affiliation(s)
- Takeshi Matsui
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Huang YH, Hsiao LT, Hong YC, Chiou TJ, Yu YB, Gau JP, Liu CY, Yang MH, Tzeng CH, Lee PC, Lin HC, Lee SD. Randomized controlled trial of entecavir prophylaxis for rituximab-associated hepatitis B virus reactivation in patients with lymphoma and resolved hepatitis B. J Clin Oncol 2013; 31:2765-72. [PMID: 23775967 DOI: 10.1200/jco.2012.48.5938] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The role of antiviral prophylaxis in preventing hepatitis B virus (HBV) reactivation before rituximab-based chemotherapy in patients with lymphoma and resolved hepatitis B is unclear. PATIENTS AND METHODS Eighty patients with CD20(+) lymphoma and resolved hepatitis B were randomly assigned to receive either prophylactic entecavir (ETV) before chemotherapy to 3 months after completing chemotherapy (ETV prophylactic group, n = 41) or to receive therapeutic ETV at the time of HBV reactivation and hepatitis B surface antigen (HBsAg) reverse seroconversion since chemotherapy (control group, n = 39). RESULTS Fifty-eight patients (72.5%) were positive for hepatitis B surface antibody, and HBV DNA was undetectable in 50 patients (62.5%). During a mean 18-month follow-up period, one patient (2.4%) in the ETV prophylactic group and seven patients (17.9%) in the control group developed HBV reactivation (P = .027). The cumulative HBV reactivation rates at months 6, 12, and 18 after chemotherapy were 8%, 11.2%, and 25.9%, respectively, in the control group, and 0%, 0%, and 4.3% in the ETV prophylactic group (P = .019). Four patients (50%) in the control group had HBsAg reverse seroconversion after HBV reactivation. The cumulative HBsAg reverse seroconversion rates at months 6, 12, and 18 since chemotherapy were 0%, 6.4%, and 16.3% in the control group, respectively, which were significantly higher than those in the ETV prophylactic group (P = .032). Patients with detectable or undetectable viral load could develop HBV reactivation and HBsAg reverse seroconversion. CONCLUSION Undetectable HBV viral load before chemotherapy did not confer reactivation-free status. Antiviral prophylaxis can potentially prevent rituximab-associated HBV reactivation in patients with lymphoma and resolved hepatitis B.
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Affiliation(s)
- Yi-Hsiang Huang
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
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Hwang JP, Vierling JM, Zelenetz AD, Lackey SC, Loomba R. Hepatitis B virus management to prevent reactivation after chemotherapy: a review. Support Care Cancer 2012; 20:2999-3008. [PMID: 22933131 PMCID: PMC3469760 DOI: 10.1007/s00520-012-1576-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/13/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy. METHODS We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library. RESULTS Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests-HBsAg, anti-HBc, and anti-HBs-allows the most thorough interpretation of a patient's serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies. CONCLUSIONS Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.
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Affiliation(s)
- Jessica P Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Xu J, Zhu H, Zhao Y, Wang X, Shen Y, Wang W, Xu F. Factors associated with hepatic dysfunction in hepatitis B-positive patients with postgastrectomy adenocarcinoma. Oncol Lett 2012; 4:471-476. [PMID: 22970045 DOI: 10.3892/ol.2012.745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/23/2012] [Indexed: 02/05/2023] Open
Abstract
In the present study, we reviewed 44 postgastrectomy adenocarcinoma patients who had hepatitis B and received treatment in the Abdominal Cancer Department of the West China Hospital between October 2006 and October 2010. Of these patients, 17 developed hepatic dysfunction. Radiotherapy is an independent risk factor to hepatic function on univariate and multivariate analysis. Grade III or IV hepatic dysfunction was developed by five patients, all of whom had received radiotherapy and had reactivated hepatic B virus (HBV). Radiotherapy is a significant risk factor to hepatic function in patients with postgastrectomy adenocarcinoma carrying HBV, thus we suggest excluding the liver from the radiation field. HBV reactivation plays a role in the development of grade III or IV hepatic dysfunction. Patients with reactivated HBV should immediately receive regular antiviral treatment.
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Affiliation(s)
- Jian Xu
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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Day FL, Link E, Thursky K, Rischin D. Current hepatitis B screening practices and clinical experience of reactivation in patients undergoing chemotherapy for solid tumors: a nationwide survey of medical oncologists. J Oncol Pract 2011; 7:141-7. [PMID: 21886492 PMCID: PMC3092651 DOI: 10.1200/jop.2010.000133] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2010] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Universal screening for chronic hepatitis B virus (HBV) before chemotherapy has been recommended by the Centers for Disease Control. We sought to determine the practice of Australian oncologists with regard to HBV screening in patients with solid tumors (STs) and their clinical experience of HBV reactivation (HBVR). METHODS A survey was sent to all consultant members of the Medical Oncology Group of Australia. One hundred eighty-eight responses (63% response rate) were received. We also reviewed the incidence of HBV in patients with STs screened at the Peter MacCallum Cancer Centre (Melbourne, Australia). RESULTS Fifty-three percent of medical oncologists screen for HBV, but only 19% screen all patients. The most common reasons given for performing screening were anecdotal experience of HBVR (46%) and perceived sufficient evidence for screening of some patient subgroups (42%). Sixty-five percent of those who screened did so only in subgroups, usually selecting patients on the basis of ethnicity (82%). Oncologists who did not screen most commonly cited inadequate evidence for a benefit of screening (72%). Twenty-two percent of oncologists had witnessed one or more HBVR events, representing one event per 45 years of respondents' practice. HBVR events reported (n = 54) consisted of asymptomatic liver test abnormalities only (44%), symptomatic hepatitis (28%), decompensated liver failure (19%), and death (7%). In 206 patients with STs screened for HBV, 1.0% (n = 2) were HBV surface antigen positive, and 14.9% hepatitis B core antibody positive. CONCLUSION The majority of Australian medical oncologists have not adopted universal HBV screening before chemotherapy. Further evidence of the benefit and cost effectiveness of universal screening in patients with STs will be required to alter practice.
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Affiliation(s)
- Fiona L. Day
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Link
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Rischin
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
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Wolff FH, Fuchs SC, Brandão AB. Absence of occult hepatitis B among blood donors in southern Brazil. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70163-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Reactivation of hepatitis B virus after transarterial chemo-embolization for hepatocellular carcinoma in one patient with negative hepatitis B surface antigen. J Hepatol 2010; 52:463-5. [PMID: 20129689 DOI: 10.1016/j.jhep.2009.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 11/04/2009] [Accepted: 11/05/2009] [Indexed: 12/04/2022]
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Lee IC, Huang YH, Chu CJ, Lee PC, Lin HC, Lee SD. Hepatitis B virus reactivation after 23 months of rituximab-based chemotherapy in an HBsAg-negative, anti-HBs-positive patient with follicular lymphoma. J Chin Med Assoc 2010; 73:156-60. [PMID: 20231001 DOI: 10.1016/s1726-4901(10)70031-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 12/23/2009] [Indexed: 01/04/2023] Open
Abstract
A 72-year-old female negative for hepatitis B surface antigen (HBsAg) and positive for antibody to hepatitis B surface antigen (anti-HBs) was diagnosed to have follicular lymphoma in 2006. Seventeen cycles of rituximab-based chemotherapy were administered over 23 months. Twelve days after the last cycle of chemotherapy, serum aminotransferase levels were elevated, and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBs, and positivity for hepatitis B virus (HBV) DNA. Antiviral treatment with entecavir was administered immediately, and the hepatitis flare was controlled. Rituximab-based chemotherapy can induce HBV reactivation even in HBsAg-negative, anti-HBs-positive patients. Early recognition and prompt antiviral treatment is crucial for patients with HBV reactivation during anticancer therapy.
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Affiliation(s)
- I-Cheng Lee
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Chu CJ, Lee SD. Occult hepatitis B virus infection in patients with chronic hepatitis C: An actor behind the scene or just a bystander? J Gastroenterol Hepatol 2010; 25:221-3. [PMID: 20136983 DOI: 10.1111/j.1440-1746.2009.06134.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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