Reactivation of hepatitis B # †

Hoofnagle, Jay H.

doi:10.1002/hep.22945

Cited by 516 publications

(469 citation statements)

References 86 publications

(119 reference statements)

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“…1 Reactivation of HBV replication with an increase of serum HBV DNA has been reported in 20%-50% of hepatitis B carriers undergoing cytotoxic chemotherapy for cancer treatment. 2,3 Reactivation of HBV may also occur in patients with resolved hepatitis B (hepatitis B surface antigen [HBsAg]-negative/antibody to hepatitis B core antigen [anti-HBc]-positive) who receive chemotherapy containing strong immunosuppressive agents such as rituximab. 4 The incidence of HBV reactivation in patients with lymphoma and resolved hepatitis B after rituximab-based therapy ranges from 1.5% to 23.8%.…”

mentioning

confidence: 99%

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

et al. 2015

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Reactivation of hepatitis B viral (HBV) infection in cancer patients undergoing chemotherapy may cause interruption of chemotherapy and lead to liver failure and death. In our institute, a computerized order entry-based alert system was introduced in September 2011 to remind healthcare providers of HBV testing when prescribing chemotherapy. Since August 2012, an order entry-based therapeutic control system has been applied to ensure HBV prophylaxis during chemotherapy. This retrospective cohort study included cancer patients receiving chemotherapy in the Kaohsiung Veterans General Hospital from November 2009 to June 2013. The prechemotherapy HBV screening rate, HBV prophylactic rate, and severe HBV acute exacerbation rate were compared between stages with different order systems. Newly diagnosed cancer patients (n 5 2512) were included. The HBV testing rate in the screening reminder stage was higher than that in the educational stage (93.5% versus 40.2%, P < 0.001), whereas the adequate HBV prophylactic rates in the two order entry-based stages were comparable (41.1% versus 39.2%). Patients in the order entry-based therapeutic control stage had a higher HBV screening rate (99.3% versus 40.2%, P < 0.001) and a higher HBV prophylactic rate (95.8% versus 39.2%, P < 0.001) than those in the educational stage. Additionally, the severe HBV acute exacerbation rate in the therapeutic control stage was lower than those in the educational and screening reminder stages (0% versus 1.2% and 1.2%, respectively; both P < 0.01). Conclusion: A computerized order entry-based therapeutic control system can provide excellent prechemotherapy HBV screening for cancer patients undergoing chemotherapy and can effectively prevent severe acute exacerbation of HBV infection in hospitals among HBV endemic areas. (HEPATOLOGY 2015;62:387-396) 4 The incidence of HBV reactivation in patients with lymphoma and resolved hepatitis B after rituximab-based therapy ranges from 1.5% to 23.8%. [5][6][7][8] Reactivation of HBV infection in cancer patients receiving chemotherapy may cause interruption of chemotherapy and, in severe cases, lead to liver failure and death. 9-11 Additionally, the prognosis of cancer may be compromised by disruption in anticancer treatment Abbreviations: ALT, alanine aminotransferase; anti-HBc, antibody to hepatitis B core antigen; CI, confidence interval; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma.From the

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confidence: 99%

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

et al. 2015

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“…While reactivation can occur spontaneously, it is commonly seen after cancer chemotherapy, immune suppression or alteration in immune function. 26 While the diagnosis of HBV reactivation is based on an abrupt rise of HBVDNA levels, which may be associated with derangement of liver functions, several cases of hepatitis are seen in HBsAg-positive patients on chemotherapy where the HBVDNA is negative and no other cause may be found. This may occur as enhanced viral replication precedes overt hepatitis and HBVDNA levels may decline by the time ALT levels peak and clinical hepatitis is apparent.…”

Section: Pathogenesis Of Hepatitis B Virus Reactivationmentioning

confidence: 99%

“…With recovery, the hepatic injury recovers and HBVDNA falls to baseline levels. 26 While reactivation of HBV is usually seen in HBsAg positive patients, it is being increasingly recognized in patients with apparently resolved HBV infection who do not have HBsAg in serum but have IgG anti-HBc in the serum. 30 Seroreversion, which is the reactivation of HBsAg in patients who are HBsAg negative and IgG anti-HBc positive, occurs relatively late in the setting of allogenic stem cell transplantation (6-52 months; median 19 months) compared to HBsAg positive patients (median 2-3 months).…”

Section: Pathogenesis Of Hepatitis B Virus Reactivationmentioning

confidence: 99%

“…[41][42][43] Reactivation with simple immunosuppression however occurs at a lower rate than with cancer chemotherapy. 26 Reactivation is uncommon during immunosuppression with low doses of corticosteroids, azathioprine or methotrexate. Reactivation is commonly associated with more potent immunosuppression as seen with TNF-alpha antagonists.…”

Section: Risk Factors Of Hepatitis B Virus Reactivationmentioning

confidence: 99%

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

Puri

2013

Journal of Clinical and Experimental Hepatology

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Exacerbations of chronic hepatitis B are common in endemic countries. Acute exacerbation of chronic hepatitis B virus (CHB-AE) causing derangement of liver functions may be seen in a flare of HBV in immune clearance phase or as a reactivation of HBV in patients with inactive or resolved HBV infection. While reactivation of HBV is usually seen in HBsAg positive patients, it is being increasingly recognized in patients with apparently resolved HBV infection who do not have HBsAg in serum but have IgG antibody to core antigen (anti-HBc) in the serum, especially so in patients on chemotherapy, immunosuppressive therapy or undergoing hematopoietic stem cell transplantation. In an icteric patient who is HBsAg positive, it may be difficult to differentiate CHB-AE from acute viral hepatitis B (AVH-B). Both may have similar clinical presentation and even IgM anti-HBc, the traditional diagnostic marker of AVH-B, may also appear at the time of exacerbation of CHB. The differentiation between CHB-AE and AVH-B is important not only for prognostication but also because management strategies are different. Most cases of AVH-B will resolve on their own, HBsAg clearance is achieved spontaneously in 90-95% of adults and treatment is rarely indicated except in the few with severe/fulminant disease. In contrast, in CHB-AE, the onset of jaundice may lead to decompensation of liver disease and treatment is warranted. The mechanisms of acute exacerbation and the differentiating features between AVH-B and CHB-AE are reviewed. ( J CLIN EXP HEPATOL 2013;3:301-312)

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“…Patients may revert from inactive carrier status or from a state of resolved HBV infection to immune active status especially in immunocompromised state. This reactivation may be as a result of medications, chemotherapy or advanced AIDS [74,75]. HBeAg clearance means HBeAg is lost and HBV DNA declines, often to undetectable levels.…”

Section: Hiv-related Immunosuppression On Hbeag Clearancementioning

confidence: 99%

HIV Co-Infection with Hepatotropic Viruses and Mycobacterial Tuberculosis

BU¹

2013

J AIDS Clin Res

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Reactivation of hepatitis B # †

Cited by 516 publications

References 86 publications

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

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

HIV Co-Infection with Hepatotropic Viruses and Mycobacterial Tuberculosis

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