Comprehensive analysis of risk factors associating with Hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy

Abstract

For cancer patients with chronic hepatitis B virus (HBV) infection, who receive cytotoxic chemotherapy, HBV reactivation is a welldescribed complication, which may result in varying degrees of liver damage. Several clinical features and the pre-chemotherapy HBV viral load have been suggested to be associated with an increased risk of developing the condition: (1) to assess the clinical and virological factors in a comprehensive manner and thereby identify those that are associated with the development of HBV reactivation; (2) to develop a predictive model to quantify the risk of HBV reactivation. In all, 138 consecutive cancer patients who were HBV carriers and undergoing chemotherapy were studied, of which 128 patients had sera available for real-time PCR HBV DNA measurement. They were followed up throughout their course of chemotherapy and the HBV reactivation rate was determined. The clinical and virological features between those who did and did not develop viral reactivation were compared. These included age, sex, baseline liver function tests, HBeAg status and viral load (HBV DNA) prior to the chemotherapy, and the use of specific cytotoxic agents. In all, 36 (26%) developed HBV reactivation. Multivariate analysis revealed pre-chemotherapy HBV DNA level, the use of steroids and a diagnosis of lymphoma or breast cancer to be significant factors. Based on real-time HBV DNA PCR assay, detectable baseline HBV DNA prior to the administration of cytotoxic chemotherapy, the use of steroids and a diagnosis of lymphoma or breast cancer are predictive factors for the development of HBV reactivation. A predictive model was developed from the current data, based on a logistic regression method.

HBV infection is associated with greater mortality in hospitalised patients compared to HCV infection or alcoholic liver disease

“…Those with HBV and risk factors like chemotherapy for lymphoma are at higher risk for reactivation 13,14 and those with reactivation are at higher risk for cirrhosis, HCC and decompensation. 11 Arguing for reactivation playing a role in higher mortality is the fact that risk factors for reactivation such as breast cancer, lymphoma, chemotherapy, solid organ transplant (excluding liver) and bone marrow transplant were more common in the HBV group compared to the HCV or ALD groups (Table S2).…”

Reactivation of Hepatitis B Virus After Glioblastoma Treatment With Temozolomide -Case Report-

“…4) The risk factors for HBV reactivation include male sex, young age, steroid use, anthracycline use, high pre-chemotherapy HBV-DNA level, and diagnosis of lymphoma or breast cancer. 3,12,13) Two possible mechanisms may explain HBV reactivation during chemotherapy: immunosuppression enhances virus replication, leading to hepatic toxicity, or chemotherapy-induced T-cell depletion dampens the host response to viral antigens, which enables broader hepatocyte infection, and following the subsequent withdrawal of cytotoxic chemotherapy, a rebound immune response results in hepatocyte destruction. 12) HBV reactivation-induced hepatitis has been defined as an increase in HBV-DNA level to 10-fold or more when compared with the baseline level, or as an absolute increase in HBV-DNA level to more than 1,000 × 10 6 genome equivalents/ml in the absence of other systemic infections.…”

“…13) HBV reactivation occurs in 38-48% of HBsAg-positive patients with lymphoma or other hematological malignancies, who are undergoing conventional therapies, including cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). 4) The risk factors for HBV reactivation include male sex, young age, steroid use, anthracycline use, high pre-chemotherapy HBV-DNA level, and diagnosis of lymphoma or breast cancer.…”

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

“…The risk of reactivation is higher in patients with replicative patients with HBeAg and HBVDNA prior to chemotherapy. 61 HBV reactivation occurs more commonly in male patients with genotype C and core promoter mutations and delayed HBeAg seroclearance. Patients with delayed HBeAg seroclearance had a higher frequency of seroreversion.…”