The development of a mutation in the precore region of the hepatitis B virus in a chronically infected individual

Reactivation of chronic hepatitis B infection following intensive chemotherapy and successful treatment with lamivudine: a case report and review of the literature

BACKGROUND

Hepatitis B virus reactivation has been reported in cancer patients following administration of chemotherapy or immunosuppressive therapy and may result in liver damage of varying degrees of severity. Although treatment is supportive in nature, lamivudine, a nucleoside analogue has been found to suppress HBV replication as evidenced by reports of 13 cases in the medical literature.

PATIENTS AND METHODS

We report a patient who achieved a successful outcome with lamivudine following reactivation of HBV during combination chemotherapy for non-Hodgkin's lymphoma, and provide a brief overview of the literature including the 13 published case reports.

RESULTS

Lamivudine therapy resulted in clinical improvement as well as in normalization of liver function tests and coagulation profile.

CONCLUSIONS

Lamivudine has been found to suppress HBV replication manifested both by histology and serum HBV-DNA levels in chronic carriers of HBV who developed reactivation of hepatic disease following chemotherapy. Physicians caring for such patients should be able to recognize this clinical challenge, and lamivudine should be considered.

Intestinal cell cycle regulation

The intestinal epithelium is maintained by a balance between proliferation, differentiation and death that occurs as cells migrate up the crypt-villus axis. Cell cycle regulators such as cyclins, cyclin-dependent kinases (Cdks) and Cdk inhibitory proteins are expressed in a distinct pattern along the crypt-villus structure, suggesting their role in controlling intestinal cells. This is supported by observations that these cell cycle proteins are regulated by growth factors, nutrients and cell-cell contact in cultured intestinal epithelial cells. One of the key regulators of intestinal cell proliferation and differentiation is transforming growth factor-beta, which is expressed in the gut epithelium.

Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies. Survey in Japan, 1987-1991

BACKGROUND

Hepatitis B (HB) virus (HBV) infection is often reactivated, leading to severe hepatitis and death. Because the actual incidence of such complications is unknown, the authors surveyed hospitals to record the incidence of these complications and to identify clinical parameters that would possibly predict the development of hepatic complications.

METHODS

First, 250 hospitals, belonging to the Japanese Society of Clinical Hematology, were surveyed for hematologic patients with chronic hepatitis or those with asymptomatic hepatitis virus infection in whom severe hepatitis related to chemotherapy occurred between 1987 and 1991. Second, 117 hospitals that responded to the first questionnaire were surveyed for HBV carriers without severe hepatitis who were prescribed chemotherapy.

RESULTS

One-half the number of patients with severe hepatitis were HBV carriers. The incidence of severe hepatitis (52.7%) and the mortality rate (23.6%) were extremely high in HBV carriers. The incidence of severe hepatitis was significantly higher in patients with chronic hepatitis or those receiving corticosteroids (P < 0.05). The mortality rate was significantly lower in patients who were positive for hepatitis Be antigen (HBeAg) and negative for the antibody to HBeAg (anti-HBe), compared with findings in other patients (P < 0.05).

CONCLUSIONS

HBV infection is a major causal agent for severe hepatitis related to chemotherapy in Japanese individuals. Chemotherapy, including corticosteroids, to treat hematologic malignancies should be considered risky in HBV carriers, especially those with chronic hepatitis or serologies negative for HBeAg and positive for anti-HBe.