Hepatitis B Virus Reactivation in Patients Receiving Cancer Chemotherapy: Natural History, Pathogenesis, and Management

Overview

Journal Hepatol Int

Publisher Springer

Specialty Gastroenterology

Date 2011 Jun 15

PMID 21670970

Citations 25

Authors

Chun-Jen Liu

Pei-Jer Chen

Ding-Shinn Chen

Jia-Horng Kao

Affiliations

Soon will be listed here.

Abstract

Chronic hepatitis B virus (HBV) infection is endemic in the Asian-Pacific region, and reactivation of HBV post-cancer chemotherapy has become an emerging clinical challenge. Patients with detectable serum HBV DNA before chemotherapy and those receiving intensive chemotherapy are particularly at a risk of HBV reactivation. Most patients with HBV reactivation are positive for hepatitis B surface antigen (HBsAg) and are, therefore, easily identified by recommended serological screening before chemotherapy. However, a small, but significant proportion of subjects who have apparently recovered from HBV infection as reflected by HBsAg negativity and hepatitis B core antibody positivity in HBV endemic areas may also experience reactivation when host immunity is severely compromised by cancer chemotherapy. Serum alanine aminotransferase, HBsAg, and/or HBV DNA should be monitored closely in these subjects and antiviral therapy should be administered immediately when any evidence of HBV reactivation is detected during chemotherapy. The prophylactic use of nucleos(t)ide analogs before chemotherapy and its continuation until reconstitution of host immunity remain the mainstay of effective prevention of hepatitis B reactivation in this special clinical entity.

Citing Articles

Hepatitis B relapse after entecavir or tenofovir alafenamide cessation under anti-viral prophylaxis for cancer chemotherapy.

Fang H, Tseng P, Hu T, Wang J, Hung C, Lu S Virol J. 2024; 21(1):79.

PMID: 38570803 PMC: 10993446. DOI: 10.1186/s12985-024-02338-6.

Guidelines for Prevention and Treatment of Chronic Hepatitis B.

Wang G, Duan Z J Clin Transl Hepatol. 2021; 9(5):769-791.

PMID: 34722192 PMC: 8516840. DOI: 10.14218/JCTH.2021.00209.

Effects of Antiviral Therapy on HBV Reactivation and Survival in Hepatocellular Carcinoma Patients Undergoing Hepatic Artery Infusion Chemotherapy.

Liu S, Lai J, Lyu N, Xie Q, Cao H, Chen D Front Oncol. 2021; 10:582504.

PMID: 33614477 PMC: 7890701. DOI: 10.3389/fonc.2020.582504.

Hepatitis B Virus Reactivation in Gastrointestinal Stromal Tumor Patients Treated With Imatinib.

Lei T, Tan F, Hou Z, Liu P, Zhao X, Liu H Front Oncol. 2021; 10:596500.

PMID: 33552970 PMC: 7862776. DOI: 10.3389/fonc.2020.596500.

Mitomycin, 5-fluorouracil, leflunomide, and mycophenolic acid directly promote hepatitis B virus replication and expression in vitro.

Ruan J, Sun S, Cheng X, Han P, Zhang Y, Sun D Virol J. 2020; 17(1):89.

PMID: 32611423 PMC: 7331192. DOI: 10.1186/s12985-020-01339-5.

References

Wu Y, Zhang J, Chen S, Chen A, Wang L, Li J . Frequencies of epitope-specific cytotoxic T lymphocytes in active chronic viral hepatitis B infection by using MHC class I peptide tetramers. Immunol Lett. 2004; 92(3):253-8. DOI: 10.1016/j.imlet.2004.01.002. View

Maini M, Boni C, Ogg G, King A, Reignat S, Lee C . Direct ex vivo analysis of hepatitis B virus-specific CD8(+) T cells associated with the control of infection. Gastroenterology. 1999; 117(6):1386-96. DOI: 10.1016/s0016-5085(99)70289-1. View

Yeo W, Johnson P . Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology. 2006; 43(2):209-20. DOI: 10.1002/hep.21051. View

Gwak G, Koh K, Kim H . Fatal hepatic failure associated with hepatitis B virus reactivation in a hepatitis B surface antigen-negative patient with rheumatoid arthritis receiving low dose methotrexate. Clin Exp Rheumatol. 2008; 25(6):888-9. View

Galbraith R, Eddleston A, Williams R, Zuckerman A . Fulminant hepatic failure in leukaemia and choriocarcinoma related to withdrawal of cytotoxic drug therapy. Lancet. 1975; 2(7934):528-30. DOI: 10.1016/s0140-6736(75)90897-1. View

Umemura T, Tanaka E, Kiyosawa K, Kumada H . Mortality secondary to fulminant hepatic failure in patients with prior resolution of hepatitis B virus infection in Japan. Clin Infect Dis. 2008; 47(5):e52-6. DOI: 10.1086/590968. View

Lim L, Wai C, Lee Y, Kong H, Lim R, Koay E . Prophylactic lamivudine prevents hepatitis B reactivation in chemotherapy patients. Aliment Pharmacol Ther. 2002; 16(11):1939-44. DOI: 10.1046/j.1365-2036.2002.01364.x. View

Saab S, Dong M, Joseph T, Tong M . Hepatitis B prophylaxis in patients undergoing chemotherapy for lymphoma: a decision analysis model. Hepatology. 2007; 46(4):1049-56. DOI: 10.1002/hep.21783. View

Lau G, Liang R, Chiu E, Lee C, Lam S . Hepatic events after bone marrow transplantation in patients with hepatitis B infection: a case controlled study. Bone Marrow Transplant. 1997; 19(8):795-9. DOI: 10.1038/sj.bmt.1700744. View

10.

Ojiro K, Naganuma M, Ebinuma H, Kunimoto H, Tada S, Ogata H . Reactivation of hepatitis B in a patient with Crohn's disease treated using infliximab. J Gastroenterol. 2008; 43(5):397-401. DOI: 10.1007/s00535-008-2165-x. View

11.

Yeo W, Chan P, Ho W, Zee B, Lam K, Lei K . Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy. J Clin Oncol. 2004; 22(5):927-34. DOI: 10.1200/JCO.2004.05.161. View

12.

Dervite I, Hober D, Morel P . Acute hepatitis B in a patient with antibodies to hepatitis B surface antigen who was receiving rituximab. N Engl J Med. 2001; 344(1):68-9. DOI: 10.1056/NEJM200101043440120. View

13.

Borentain P, Colson P, Coso D, Bories E, Charbonnier A, Stoppa A . Clinical and virological factors associated with hepatitis B virus reactivation in HBsAg-negative and anti-HBc antibodies-positive patients undergoing chemotherapy and/or autologous stem cell transplantation for cancer. J Viral Hepat. 2009; 17(11):807-15. DOI: 10.1111/j.1365-2893.2009.01239.x. View

14.

Dai M, Wu P, Shyu R, Lu J, Chao T . Hepatitis B virus reactivation in breast cancer patients undergoing cytotoxic chemotherapy and the role of preemptive lamivudine administration. Liver Int. 2004; 24(6):540-6. DOI: 10.1111/j.1478-3231.2004.0964.x. View

15.

Lau G, Leung Y, Fong D, Au W, Kwong Y, Lie A . High hepatitis B virus (HBV) DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic cell transplantation. Blood. 2002; 99(7):2324-30. DOI: 10.1182/blood.v99.7.2324. View

16.

Law J, Al Ali J, Harrigan P, Sherlock C, Savage K, Yoshida E . Fatal postlymphoma chemotherapy hepatitis B reactivation secondary to the emergence of a YMDD mutant strain with lamivudine resistance in a noncirrhotic patient. Am J Hematol. 2006; 81(12):969-72. DOI: 10.1002/ajh.20737. View

17.

Hui C, Cheung W, Au W, Lie A, Zhang H, Yueng Y . Hepatitis B reactivation after withdrawal of pre-emptive lamivudine in patients with haematological malignancy on completion of cytotoxic chemotherapy. Gut. 2005; 54(11):1597-603. PMC: 1774754. DOI: 10.1136/gut.2005.070763. View

18.

Czuczman M, Weaver R, Alkuzweny B, Berlfein J, Grillo-Lopez A . Prolonged clinical and molecular remission in patients with low-grade or follicular non-Hodgkin's lymphoma treated with rituximab plus CHOP chemotherapy: 9-year follow-up. J Clin Oncol. 2004; 22(23):4711-6. DOI: 10.1200/JCO.2004.04.020. View

19.

Kusumoto S, Tanaka Y, Mizokami M, Ueda R . Clinical significance of hepatitis B virus (HBV)-DNA monitoring to detect HBV reactivation after systemic chemotherapy. J Clin Oncol. 2010; 29(4):e100. DOI: 10.1200/JCO.2010.33.0332. View

20.

Ostuni P, Botsios C, Punzi L, Sfriso P, Todesco S . Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate. Ann Rheum Dis. 2003; 62(7):686-7. PMC: 1754595. DOI: 10.1136/ard.62.7.686. View