Hepatitis B and C Infection in Children Undergoing Chemotherapy or Bone Marrow Transplantation

Abstract

Despite preventive measures, patients who have cancer or who undergo bone marrow transplantation remain at higher risk of viral infection since they often receive multiple blood products. This category of patients also includes subjects from countries that are highly endemic for hepatitis B virus and hepatitis C virus infection and who travel to developed countries for specialized treatment. This review discusses the current opinions concerning the diagnostic, clinical, and therapeutic aspects of hepatitis B and C virus infection in different groups of patients: children with chronic infection before chemotherapy, children infected during chemotherapy or bone marrow transplantation, and patients with chronic infection after the end of treatment.

Investigating hepatitis B immunity in patients presenting to a paediatric haematology and oncology unit in South Africa

“…[1,2] Active immunisation against HBV has been shown to be effective in patients with cancer. [3] The role of passive immunisation using a specific immune globulin containing a high titre of antiHBs (HBIG) in combination with hepatitis B vaccine has been well described in the setting of postexposure prophylaxis following perinatal exposure for infants born to HBsAgpositive mothers.…”

“…[1] The higher prevalence can be explained by the immune suppression induced by cytotoxic chemotherapy, which leads to increased susceptibility. [2,3] Immune suppression may also lead to reactivation of occult HBV infection and increased HBV replication.…”

Viral Hepatitis: Manifestations and Management Strategy

“…34 Chronic liver inflammation in HCV-infected patients may cause endothelial cell membrane changes of hepatic sinusoids or hepatocytes, which, when associated with the drug action, may stimulate the formation of microthrombi, thus triggering VOD. 40 Since it is often difficult in an HCV-positive patient to discriminate the etiology of ALT elevation (drug, GVHD, VOD, HCV, etc. ), a liver biopsy is often required.…”

Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virus-(HBV-)Infektion: „Upgrade” der Leitlinie, AWMF-Register-Nr.: 021/011

“…Kinder und Jugendliche mit gleichzeitiger immunsuppressiver Therapie kçnnen im Indikationsfall z. B. zur Verringerung eines Reaktivierungsrisikos mit einem Nukleosid-/Nukleotid-Analogon behandelt werden [140] (IV). liche Dosis sollte 5 Mio.…”

“…Bei einigen Patienten tritt die Serokonversion erst mehrere Monate nach Beendigung der Therapie ein [25,272] (IV). Kinder mit einer vertikalen Transmission von HBV, geringer entzündlicher Aktivität im Lebergewebe, Patienten mit einer zusätzlichen HDV-Infektion und Kinder mit Immundefizienz sprechen schlechter auf die Therapie an [140,208] (IV). Nach Beendigung der Interferontherapie kann es zu einer Reaktivierung (Wahrscheinlichkeit ca.…”