Reactivation of hepatitis B virus associated with chemotherapy and immunosuppressive agent (original) (raw)
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Hepatitis B Reactivation in Immunosupressed Patients, Prophylaxis and Management
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 2017
Hepatitis B virus (HBV) reactivation is a clinical problem associated with high morbidity and mortality rates. Currently, this incidence seems to be increasing around the world. The reactivation commonly developes in immunosuppressed individuals, although it may also occur spontaneously. Individuals who develop malignancy with chronic hepatitis B virus infection are at high-risk for hepatitis B virus reactivation, since they are closely related to immunosuppression, especially when undergoing chemotherapy. The loss of immune control in these patients may results in the reactivation of HBV replication within hepatocytes. This review article will focus on HBV reactivation related to immunosuppressed patients, immunosuppressive drug classes and corresponding risk estimates of hepatitis B virus reactivation, screening test recommended before getting this drugs, choice of antiviral drugs for prophylaxis, and duration of prophylaxis treatment based on European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), and Asian Pacific for the Study of the Liver (APASL) guidelines.
Hepatitis B reactivation after chemotherapy: two decades of clinical research
Hepatology international, 2008
Hepatitis due to hepatitis B virus reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. With the characterization of the underlying pathogenesis, much progress in the management of this important clinical problem has been made in the past 2 decades. By year 2008, it is mandatory to screen for hepatitis B surface antigen status before initiating intensive chemotherapy or immunosuppressive therapy. All those who are hepatitis B surface antigen positive should be started on preemptive nucleos(t)ide analogues. However, there remains important issues, such as the type and duration of nucleos(t)ide analogue therapy, which need to be understood. As not all hepatitis B surface antigen-positive patients will suffer from HBV reactivation, it is therefore useful to identify risk factors related to HBV reactivation so that patients will not be treated unnecessarily with nucleos(t)ide analogues. To date, a high baseline level of v...
Multicenter cooperative case survey of hepatitis B virus reactivation by chemotherapeutic agents
Hepatology research : the official journal of the Japan Society of Hepatology, 2015
The purpose of this multicenter cooperative study was to elucidate the clinical features of hepatitis B virus (HBV) reactivation by chemotherapeutic agents and the patient outcomes after HBV reactivation by a retrospective review of accumulated patients' medical records. Records of a total of 27 patients (hematological malignancy, 14 patients; solid tumor, 13 patients) from 11 institutions who were diagnosed between June 2005 and October 2010 as having HBV reactivation following chemotherapy were reviewed. Of the 27 patients with reactivation, 16 patients were hepatitis B surface antigen (HBsAg) positive and 11 were HBsAg negative prior to the commencement of chemotherapy. Of the 11 patients who were HBsAg negative prior to the chemotherapy, 10 had hematological malignancies and one had a solid tumor. Of the 14 patients with hematological malignancies with HBV reactivation enrolled in the study, the reactivation occurred more than 12 months after the completion of chemotherapy i...
Reactivation of hepatitis B: pathogenesis and clinical implications
Current infectious disease reports, 2009
Chronic hepatitis B virus (HBV) is estimated to be present in 350 million people worldwide. One of its major complications is reactivation of dormant HBV, which is associated with significant morbidity and mortality. Although reactivation can occur spontaneously, the most common risk factor is initiation of immunosuppression. As the use of immunosuppressive therapy increases, the incidence of HBV reactivation is expected to rise. Screening with serologic markers for hepatitis B is recommended before initiating immunosuppressive therapy. In patients with no evidence of HBV infection, immunization is recommended. In chronic carriers, prophylactic antiviral treatment has been shown to decrease overall morbidity and mortality. Patients with inactive HBV should be monitored closely during immunosuppressive treatment with alanine transaminase and serum HBV-DNA levels and treated promptly if they develop HBV reactivation. Although HBV reactivation is a serious complication, it can be preve...
FARMACIA, 2020
Hepatitis B virus (HBV) infection continues to be a major global health problem. HBV reactivation has been documented both in HBsAg positive patients and in individuals with occult hepatitis B infection (OBI)-negative for HBsAg but positive for anti-hepatitis B core IgG antibodies (IgG anti-HBc). HBV reactivation has a major clinical significance, especially in patients receiving chemoimmunotherapy for haematological malignancies (HM). We aimed to evaluate clinical and epidemiological patterns of HBV reactivation in the OBI group compared to the HBV reactivation in HBsAg positive patients (non-OBI group) during chemoimmunotherapy for HM. We enrolled 63 patients with HM and at least one serological marker of HBV infection, including 10 patients with OBI. Viral reactivation occurred overall in 29/63 patients (46.2%). In the OBI group, seven patients (70%) had reactivation with HBsAg reverse seroconversion after a mean of 5.5 chemotherapy cycles, compared to 22 patients (41.5%) in the non-OBI group (p = 0.0097). All patients with viral reactivation were treated with antiviral therapy (entecavir) with a favourable outcome. No deaths occurred due to hepatic failure and the risk of reactivation was not correlated with age, sex and type of HM in our patients. Rezumat Infecția cu virus hepatitic B (VHB) continuă să reprezinte o problemă majoră de sănătate publică la nivel mondial. Reactivarea infecției VHB a fost observată atât la pacienții AgHBs pozitivi, cât și la cei cu AgHBs negativ dar care prezentau anticorpi anti-HBc IgG (OBI). Reactivarea infecției VHB are o mare importanță clinică, mai ales la persoanele aflate sub chimioimunoterapie pentru hemopatii maligne (HM). Studiul de față a avut ca obiectiv evaluarea caracteristicilor clinice și epidemiologice ale reactivării infecției VHB la pacienții cu OBI comparativ cu pacienții cu AgHBs pozitiv (non-OBI) în timpul chimio-imunoterapiei pentru HM. Lotul a cuprins 63 pacienți care aveau cel puțin un marker serologic pozitiv pentru VHB, dintre care 10 pacienți au avut OBI. În ansamblul lotului de studiu, reactivarea virală a fost observată în 29/63 cazuri (46,2%). În grupul OBI reactivarea virală VHB a fost identificată la 7 pacienți (70%) care au prezentat revers seroconversie AgHBs în medie după 5,5 cicluri chimioterapice, față de 22 cazuri (41,5%) în grupul non-OBI (p = 0,0097). Toți pacienții cu reactivare virală VHB au primit tratament antiviral cu entecavir și au avut o evoluție favorabilă. Nu s-a înregistrat nici un deces datorat insuficienței hepatice, iar riscul de reactivare nu s-a corelat cu vârsta, sexul sau tipul histologic al afecțiunii hematologice la pacienții aflati în studiu.
Current trends in management of hepatitis B virus reactivation in the biologic therapy era
World Journal of Gastroenterology, 2011
Hepatitis B virus (HBV) reactivation represents an emerging cause of liver disease in patients undergoing treatment with biologic agents. In particular, the risk of HBV reactivation is heightened by the use monoclonal antibodies, such as rituximab (anti-CD20) and alemtuzumab (anti-CD52) that cause profound and longlasting immunosuppression. Emerging data indicate that HBV reactivation could also develop following the use of other biologic agents, such as tumor necrosis factor (TNF)-α inhibitors. When HBV reactivation is diagnosed, it is mandatory to suspend biologic treatment and start antiviral agents immediately. However, preemptive antiviral therapy prior to monoclonal antibody administration is crucial in preventing HBV reactivation and its clinical consequences. Several lines of evidence have shown that risk of HBV reactivation is greatly reduced by the identification of high-risk patients and the use of prophylactic antiviral therapy. In this article, we discuss current trends in the management of HBV reactivation in immunosuppressed patients receiving biologic therapy, such as rituximab, alemtuzumab and TNF-α antagonists.
Journal of Medical Virology, 2000
Hepatitus B virus (HBV) reactivation is a welldescribed complication in cancer patients who receive cytotoxic chemotherapy and may result in varying degrees of liver damage. As chemotherapy is used increasingly in cancer patients, HBV reactivation during cytotoxic treatment may become a more common problem. In lymphoma patients, the incidence of chronic HBV infection has been reported to be 26%, of whom 47% developed HBV reactivation during chemotherapy. However, corresponding data for patients with other malignancies undergoing cytotoxic chemotherapy are not known. In this prospective study, hepatitis B surface antigen (HBsAg) was determined in 626 consecutive cancer patients who received cytotoxic chemotherapy over a 12-month period. Seventy-eight patients (12%) were found to be HBsAg positive. Thirty-four (44%) developed raised alanine transaminase during their course of chemotherapy. In these 34 patients, hepatitis was attributed to HBV reactivation in 15 patients (44%), chronic active HBV infection in 1 patient (3%), hepatitis C infection in 1 patient (3%), malignant hepatic infiltration in 2 patients (6%), and the use of hepatotoxic chemotherapeutic agents in 11 patients (32%). The causes of hepatitis were unknown in 4 patients (12%). HBV reactivation was more likely to develop in patients who were male, younger age, HBeAg seropositive, and those with lymphoma. Presence of malignant hepatic infiltration, baseline pre-treatment alanine transaminase, total bilirubin, and HBV DNA levels did not correlate with the development of HBV reactivation. Of the 15 patients who developed HBV reactivation, antiviral therapy with lamivudine was available and used in 9. There was no HBV-related mortality during chemotherapy. It is concluded that in patients with chronic HBV infection under chemotherapy, HBV reactivation occurs in nearly 20% of them and accounts for 44% of hepatitis cases. The risk factors identified include male sex, younger age, HBeAg seropositive, and the diagnosis of lymphoma. In HBV endemic areas, patients with risk factors for HBV reactivation should be identified prior to receiving cytotoxic treatment and monitored closely. The potential benefit of lamivudine requires further confirmation.
Hepatology International
Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liverrelated morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.