Admissions for hepatitis B reactivation in patients receiving immunosuppressive therapy remain unchanged from 1999 to 2014

Chronic Hepatitis B, C, and D

Chronic hepatitis B, C, and D virus infections contribute significantly to the morbidity and mortality of immunocompromised individuals. To contextualize discussion of these infections in immunocompromised patients, this paper provides an overview of aspects of infection in normal hosts. It then describes differences in disease, diagnostic testing, and therapeutic management observed in immunocompromised patients.

Reactivation of hepatitis B virus in cancer patients treated with chemotherapy for solid tumors. Is the prophylaxis really required?

BACKGROUND

Reactivation of hepatitis B virus during cancer chemotherapy for non-hematological tumors is not fully clear.

AIM

To evaluate the risk of hepatitis B virus reactivation in carriers of hepatitis B virus cancer patients treated with chemotherapy for solid tumors.

METHODS

Two hundred sixty-seven patients with solid tumors were consecutively enrolled: 13 (4.8%) were hepatitis B s-antigen positive, of whom 6 were documented inactive carriers and 7 had chronic liver disease. Thirty-two patients (12%) were hepatitis B s-antigen negative/hepatitis B c-antibody positive. Hepatitis B virus inactive carriers were followed every 3 months by alanine aminotransferases, hepatitis B virus-DNA; whereas hepatitis B virus occult carriers were followed every 3 months by alanine aminotransferases and hepatitis B s-antigen.

RESULTS

None of the 38 total patients with inactive or occult B infection who did not receive prophylaxis presented hepatitis B virus reactivation during the follow-up period.

CONCLUSION

This study suggests that, in hepatitis B s-antigen negative patients who undergo chemotherapy for solid tumors, hepatitis B and c-antibody screening results are not relevant to clinical decision and can be avoided. Larger studies are needed to establish whether the risk of reactivation of HBV during chemotherapy is negligible in this subset of patients and they could not be monitored for HBV reactivation.

Treatment of chronic hepatitis B infection-2017

Since the registration of the first effective nucleoside analogue against the hepatitis B virus almost two decades ago, major progress has been made in the management of chronic hepatitis B infection. However, hepatitis B-related morbidity and mortality remain a major global health threat. This is partly due to the escalating costs and the decrease in compliance related to the need for prolonged therapy for most patients who cannot be "cured". New biomarkers such as quantitative hepatitis B surface antigen might help to determine if hepatitis B e antigen negative patients can be taken off nucleos(t)ide analogues. On the other hand, novel compounds that target the viral life cycle or modulate host immune response are in the pipeline. In the next few years, one should expect breakthrough advancement to be made leading to a "cure" for patients with chronic hepatitis B infection by inducing hepatitis surface antigen loss with or without the development of the hepatitis B surface antibody. In addition, attention and necessary actions should also be taken in patients with hepatitis B infection who are being treated with immunosuppressive therapy and direct anti-viral (DAAs) agents for hepatitis C infection to prevent hepatitis from hepatitis B reactivation.

Need to improve awareness and management of hepatitis B reactivation in patients receiving immunosuppressive therapy

Hepatitis B reactivation in patients receiving immunosuppressive therapy is not an uncommon event because of upsurge in the development of more potent and new immunosuppressive therapy (IST) including monoclonal antibodies leading to profound B cell depletion. However, this condition is still not being commonly made known to practising clinicians. More importantly, serious adverse outcomes including liver decompensation and death have been reported from time to time. This is likely related to the insufficient efforts to disseminate the knowledge or inattentive attitude from clinicians towards the need for hepatitis B virus screening before starting IST. It is of crucial importance, as these adverse outcomes are largely preventable by prophylactic or early treatment by antiviral agents. The risk of hepatitis B reactivation depends on the type and duration of the IST, patient characteristics and disease conditions. While we are eagerly waiting for a more cohesive consensual management recommendations from the different specialties who are involved in managing these patients, consolidated data are readily available for clinicians to define whether their patients would have a low or a high risk of hepatitis B reactivation. A management strategy without ambiguity should be formulated.