Oncologists and Hepatitis B: A Survey to Determine Current Level of Awareness and Practice of Antiviral Prophylaxis to Prevent Reactivation

Khokhar, Omar; Farhadi, Arash; McGrail, Lisa H.; Lewis, James H.

doi:10.1159/000183731

Cited by 42 publications

(23 citation statements)

References 77 publications

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“…A recent survey, involving on-cologists in the US, highlighted a reduced prevalence of practitioner applied universal screening for HBV infection (14%) and that only 56% were aware of the availability of prophylactic therapy [75] . In addition, it is interesting to note that in its recent provisional clinical opinion on chronic HBV infection screening in patients receiving CHT, the American Society of Clinical Oncology states that there is insufficient evidence of the net benefits and harms of routine HBV screening in these individuals.…”

Section: Managementmentioning

confidence: 99%

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

Marignani¹

2012

WJGO

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Hepatitis B virus (HBV) infection affects a large part of the world population. Within the different virological HBV categories that have been identified, patients with occult HBV infection represent a peculiar group. These individuals harbor a replication competent virus, inhibited in its replicative function. Accordingly, cases of reactivations have been observed in immunosuppressed individuals who lose immunological control over the infection. Patients with hematological malignancies (HM) are treated with intense myelo-and immunosuppressive chemotherapy regimens which favor HBV reactivation. This event can have severe consequences, such as hepatitis flare, hepatic failure and even death. In addition, it can lead to delays or interruptions of curative treatments, resulting in a decreased disease free and overall survival. In this review, we will examine the event of HBV reactivation in patients with signs of resolved HBV infection undergoing treatment for HM and propose possible management strategies.

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Section: Managementmentioning

confidence: 99%

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

Marignani¹

2012

WJGO

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“…While screening for hepatitis B is recommended by hepatology society guidelines [119] and TNF-alpha antagonists package labeling, it is performed infrequently. Our group has reported inadequate screening for hepatitis B in oncology and rheumatology patients receiving TNF-alpha antagonist therapy [120,121] . It is recommended that efforts be made to screen all patients universally for hepatitis B prior to initiating therapy with biologics [122,123] .…”

Section: Hepatic Injury From Reactivation Of Viral Hepatitis On Ibd Tmentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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Patients with inflammatory bowel disease (IBD) are at risk for hepatobiliary disease and toxicity, and the diagnosis of drug-induced liver disease in patients being treated for IBD can represent a clinical challenge. There are a number of disease states associated with IBD, which are primary sclerosing cholangitis, cholangiocarcinoma and autoimmune hepatitis. There is a wide spectrum of hepatic injury that can occur from the agents used to treat IBD, such as acute or chronic hepatic injury directly attributable to the drugs used to treat IBD (e.g. sulfasalazine, mesalamine, thiopurines, methotrexate, TNF antagonists, quinolone antibiotics); liver toxicity from drugs used to treat complications of immunomodulators and TNF antagonists (e.g. isoniazid for treatment of reactivation tuberculosis), and exacerbation of underlying chronic viral hepatitis with infliximab and other TNF antagonists. Thiopurines are also associated with the development of hepatic vascular lesions, such as nodular regenerative hyperplasia and peliosis hepatic. In addition, biologics can be associated with the reactivation of underlying chronic viral hepatitis, mandating universal screening prior to initiation of TNF-alpha antagonist therapy.

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“…However, among specialists who screen, only 46% order HBcAb as part of the screening workup [70••]. Another study [72] conducted among oncologists revealed that 20% were not aware of HBV reactivation and only 56% were aware of need for prophylactic antiviral therapy. Only 38% of oncologists in the study screened patients for HBV prior to chemotherapy.…”

Section: Awarenessmentioning

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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Oncologists and Hepatitis B: A Survey to Determine Current Level of Awareness and Practice of Antiviral Prophylaxis to Prevent Reactivation

Cited by 42 publications

References 77 publications

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

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

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