Avoid the tragedy of hepatitis B reactivation in immunosuppressed patients

Foont, Julie; Schiff, Eugene R.

doi:10.1038/ncpgasthep0740

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…Despite the limitations of the studies included in this review, it seems justifiable to suggest that persons who have a high-or intermediate-risk for exposure to hepatitis B be identified and screened for HBsAg before chemotherapy is initiated. All patients who test positive for HBsAg and are undergoing chemotherapy should be considered for preventive lamivudine therapy (5,35). Although the optimal duration of treatment remains inconclusive, most experts recommend starting lamivudine therapy before chemotherapy and continuing treatment for at least 6 months or more after stopping chemotherapy (28).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation during Chemotherapy

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation during Chemotherapy

et al. 2008

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“…In some patients with negative HBsAg and evidence of past exposure, the presence of covalently closed circular DNA (cccDNA) in the hepatocytes can provide a template for HBV reactivation [23]. With persistence of cccDNA in these individuals and the possibility of potential recurrence in the setting of immunosuppression, some recommend that prophylaxis be used in these patients [43]. However, in HBV-endemic areas this would result in starting a large number of patients on prophylactic HBV antiviral therapy, thereby increasing chance of resistance and health care cost tremendously.…”

Section: Prophylaxis For Patients With Prior Hbv Exposurementioning

confidence: 99%

Chemoprevention of Patients with Hepatitis B Receiving Chemotherapy or Bone Marrow Transplant

Gopal

Min

2010

Curr Hepatitis Rep

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Hepatitis B virus (HBV) reactivation is a common but preventable complication of immunosuppression. With the advent of new therapies that provide efficient and prolonged immunosuppression, the incidence of HBV reactivation is likely to increase. The clinical presentation can range from mildly elevated aminotransferase values to fatal fulminant hepatitis. Despite prompt antiviral therapy, the mortality rates remain high, and it can adversely affect the outcome of immunosuppressive therapy for the underlying hematological disease. Over the past decade, several studies evaluated the risk of HBV reactivation, role of serological tests, and effectiveness of antiviral therapies in preventing severe hepatic dysfunction among patients undergoing immunosuppressive therapy. Studies show that HBV antiviral therapy given prior to chemotherapy may prevent HBV replication, and reduce the risk of HBV reactivation during the immunosuppression period. This article reviews the current literature and society guidelines on HBV reactivation, risk factors, and prophylaxis for HBV reactivation in patients undergoing chemo-/immunosuppressive therapy.

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“…Use of antiviral agents as prophylaxis against HBV in HBsAg‐seropositive patients undergoing cytotoxic chemotherapy is becoming a standard strategy [103,111,112]. But for patients with OHB and those who are serologically HBV DNA negative but anti‐HBc positive (anti‐HBs <100 mIU/mL) and who are receiving corticosteroids with B and T‐cell antibodies, guidelines for the use of antiviral agents have not been established.…”

Section: Clinical Significance Of Occult Hepatitis Bmentioning

confidence: 99%

Occult hepatitis B virus infection: a covert operation

Hollinger

Sood

2010

Journal of Viral Hepatitis

171

173

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Detection of occult hepatitis B requires assays of the highest sensitivity and specificity with a lower limit of detection of less than 10 IU/mL for hepatitis B virus (HBV) DNA and <0.1 ng/mL for hepatitis B surface antigen (HBsAg). This covert condition is relatively common in patients with chronic hepatitis C virus (HCV) that seems to exert some influence on the replicative capacity and latency of HBV. Detection of virus-specific nucleic acid does not always translate into infectivity, and the occurrence of primer-generated HBV DNA that is of partial genomic length in immunocompetent individuals who have significant levels of hepatitis B surface antibody (anti-HBs) may not be biologically relevant. Acute flares of alanine aminotransferase (ALT) that occur during the early phase of therapy for HCV or ALT levels that remain elevated at the end of therapy in biochemical nonresponders should prompt an assessment for occult hepatitis B. Similarly, the plasma from patients with chronic hepatitis C that is hepatitis B core antibody (anti-HBc) positive (+/-anti-HBs at levels of <100 mIU/mL) should be examined for HBV DNA with the most sensitive assay available. If a liver biopsy is available, immunostaining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) should be contemplated and a portion of the sample tested for HBV DNA. This is another reason for optimal collection of a specimen (e.g. two passes with a 16-guage needle under ultrasound guidance). Transmission of HBV to immunosuppressed orthotopic liver transplant recipients by donors with occult hepatitis B (OHB) will continue to occupy the interests of the transplant hepatologist. As patients with OHB may have detectable HBV DNA in serum, peripheral blood mononuclear cells (PBMC) and/or liver that can be reactivated following immunosuppression or intensive cytotoxic chemotherapy, the patient needs to be either monitored or treated depending on the pretreatment serological results such as an isolated anti-HBc reaction or a detectable HBV DNA.

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Avoid the tragedy of hepatitis B reactivation in immunosuppressed patients

Cited by 5 publications

References 4 publications

Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation during Chemotherapy

Systematic Review: The Effect of Preventive Lamivudine on Hepatitis B Reactivation during Chemotherapy

Chemoprevention of Patients with Hepatitis B Receiving Chemotherapy or Bone Marrow Transplant

Occult hepatitis B virus infection: a covert operation

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