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Unver Ulusoy T, Tıglıoglu P, Demirköse H, Albayrak M, Şencan İ. Change in Hepatitis B Surface Antibody Titers After Chemotherapy in Patients With Hematological Malignancies. Cureus 2024; 16:e51572. [PMID: 38314000 PMCID: PMC10836041 DOI: 10.7759/cureus.51572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background The change in hepatitis B surface antibody (anti-HBs) titers after chemotherapy (CT) in patients with hematological malignancy, affecting factors, and its clinical implications have not been sufficiently understood. Therefore, we aim to evaluate the change in anti-HBs titers and hepatitis B virus reactivation (HBVr) after CT. Methods This retrospective study enrolled patients with hematological malignancies who received CT between 2013 and 2021. All patients were followed up for HBVr and a change in anti-HBs titers for one year. Results Overall, 192 patients were included. In total, 33.9% of the patients were anti-HBs (+) and 26% of the patients were anti-HBc (+) ± anti-HBs (+). Hepatitis B virus (HBV) prophylaxis was given to 35 (70%) of 50 Anti-HBc (+) patients. Tenofovir disoproxil fumarate and entecavir prophylaxis were initiated in 25 (71.4%) and 10 (28.6%) patients, respectively. A significant decrease was found in anti-HBs titers of all patients (p=0.017). A significant decrease was also found in anti-HBs titers of HBc IgG (+) patients and those who received four or more courses of CT (p=0.025; p=0.041). HBVr was not diagnosed in any of the patients. Conclusion Chemotherapeutic agents administered for hematological malignancy have serious immunosuppression effects. In these patients, anti-HBs titers may decrease or become negative one year after CT. Anti-HBs titer before CT or its change after CT may not constitute a risk for HBVr patients who received HBV prophylaxis in line with current guidelines and these recommendations.
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Affiliation(s)
- Tülay Unver Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, TUR
| | - Pınar Tıglıoglu
- Department of Hematology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, TUR
| | - Hacer Demirköse
- Department of Public Health, Pursaklar District Health Directorate, Ankara, TUR
| | - Murat Albayrak
- Department of Haematology, Ankara Etlik City Hospital, Ankara, TUR
| | - İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, TUR
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
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Caviglia GP, Zorzi A, Rizzetto M, Mirandola M, Olivero A, Carolo G. Hepatitis B Virus Reactivation upon Immunosuppression: Is There a Role for Hepatitis B Core-Related Antigen in Patients with Immune-Escape Mutants? A Case Report. Diagnostics (Basel) 2021; 11:diagnostics11122185. [PMID: 34943420 PMCID: PMC8700299 DOI: 10.3390/diagnostics11122185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/06/2023] Open
Abstract
The reactivation of hepatitis B virus (HBVr) in patients undergoing pharmacological immunosuppression is a potentially fatal clinical event that may occur in patients with overt or occult HBV infection. The risk of HBVr is mainly determined by the type of immunosuppressive therapy and the HBV serologic profile, with a higher risk in patients positive for the hepatitis B surface antigen (HBsAg), and a lower risk in HBsAg-negative/antibodies to core antigen-positive subjects. Notably, a considerable proportion of patients experiencing HBVr showed a high degree of variability of the HBV S gene, possibly leading to immune escape mutants. These mutations, usually in the “a-determinant” of the HBsAg, can cause diagnostic problems and consequently hamper the appropriate management strategy of patients at risk of HBVr. Here, we describe a case of HBVr in a patient with a diagnosis of chronic myeloid leukemia and a previous history of kidney transplant, providing evidence of the potential usefulness of hepatitis B core-related antigen measurement in patients with HBV immune-escape mutants at risk of viral reactivation.
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Affiliation(s)
- Gian Paolo Caviglia
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
- Correspondence: (G.P.C.); (A.O.); Tel.: +39-011-6333532 (G.P.C.)
| | - Antonella Zorzi
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, 37126 Verona, Italy;
| | - Mario Rizzetto
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (M.M.); (G.C.)
| | - Antonella Olivero
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
- Correspondence: (G.P.C.); (A.O.); Tel.: +39-011-6333532 (G.P.C.)
| | - Giada Carolo
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (M.M.); (G.C.)
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Chen R, Wang T, Song J, Pu D, He D, Li J, Yang J, Li K, Zhong C, Zhang J. Antiviral Drug Delivery System for Enhanced Bioactivity, Better Metabolism and Pharmacokinetic Characteristics. Int J Nanomedicine 2021; 16:4959-4984. [PMID: 34326637 PMCID: PMC8315226 DOI: 10.2147/ijn.s315705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/11/2021] [Indexed: 12/11/2022] Open
Abstract
Antiviral drugs (AvDs) are the primary resource in the global battle against viruses, including the recent fight against corona virus disease 2019 (COVID-19). Most AvDs require multiple medications, and their use frequently leads to drug resistance, since they have poor oral bioavailability and low efficacy due to their low solubility/low permeability. Characterizing the in vivo metabolism and pharmacokinetic characteristics of AvDs may help to solve the problems associated with AvDs and enhance their efficacy. In this review of AvDs, we systematically investigated their structure-based metabolic reactions and related enzymes, their cellular pharmacology, and the effects of metabolism on AvD pharmacodynamics and pharmacokinetics. We further assessed how delivery systems achieve better metabolism and pharmacology of AvDs. This review suggests that suitable nanosystems may help to achieve better pharmacological activity and pharmacokinetic behavior of AvDs by altering drug metabolism through the utilization of advanced nanotechnology and appropriate administration routes. Notably, such AvDs as ribavirin, remdesivir, favipiravir, chloroquine, lopinavir and ritonavir have been confirmed to bind to the severe acute respiratory syndrome-like coronavirus (SARS-CoV-2) receptor and thus may represent anti-COVID-19 treatments. Elucidating the metabolic and pharmacokinetic characteristics of AvDs may help pharmacologists to identify new formulations with high bioavailability and efficacy and help physicians to better treat virus-related diseases, including COVID-19.
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Affiliation(s)
- Ran Chen
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Tingting Wang
- Biochemistry and Molecular Biology Laboratory, Experimental Teaching and Management Center, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jie Song
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Daojun Pu
- Pharmaceutical Institute, Southwest Pharmaceutical Limited Company, Chongqing, 400038, People's Republic of China
| | - Dan He
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jianjun Li
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jie Yang
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Kailing Li
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Cailing Zhong
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jingqing Zhang
- Chongqing Research Center for Pharmaceutical Engineering, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
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Canzoni M, Marignani M, Sorgi ML, Begini P, Biondo MI, Caporuscio S, Colonna V, Casa FD, Conigliaro P, Marrese C, Celletti E, Modesto I, Peragallo MS, Laganà B, Picchianti-Diamanti A, Rosa RD, Ferlito C, Salemi S, D’Amelio R, Stroffolini T. Prevalence of Hepatitis B Virus Markers in Patients with Autoimmune Inflammatory Rheumatic Diseases in Italy. Microorganisms 2020; 8:microorganisms8111792. [PMID: 33207663 PMCID: PMC7696870 DOI: 10.3390/microorganisms8111792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection may be reactivated by immunosuppressive drugs in patients with autoimmune inflammatory rheumatic diseases. This study evaluates HBV serum markers' prevalence in rheumatic outpatients belonging to Spondyloarthritis, Chronic Arthritis and Connective Tissue Disease diagnostic groups in Italy. The study enrolled 302 subjects, sex ratio (M/F) 0.6, mean age ± standard deviation 57 ± 15 years, 167 (55%) of whom were candidates for immunosuppressive therapy. The Spondyloarthritis group included 146 subjects, Chronic Arthritis 75 and Connective Tissue Disease 83 (two patients had two rheumatic diseases; thus, the sum is 304 instead of 302). Ten subjects (3%) reported previous anti-HBV vaccination and tested positive for anti-HBs alone with a titer still protective (>10 IU/mL). Among the remaining 292 subjects, the prevalence of positivity for HBsAg, isolated anti-HBc, anti-HBc/anti-HBs, and any HBV marker was 2%, 4%, 18%, and 24%, respectively. A total of 26/302 (9%) patients with γ-globulin levels ≤0.7 g/dL were more frequently (p = 0.03455) prescribed immunosuppressive therapy, suggesting a more severe rheumatic disease. A not negligible percentage of rheumatic patients in Italy are at potential risk of HBV reactivation related to immunosuppressive therapy. Before starting treatment, subjects should be tested for HBV markers. Those resulting positive should receive treatment or prophylaxis with Nucleos (t) ides analogue (NUCs) at high barrier of resistance, or pre-emptive therapy, according to the pattern of positive markers. HB vaccination is recommended for those who were never exposed to the virus.
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Affiliation(s)
- Marco Canzoni
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
- Correspondence: (M.C.); (M.M.); Tel.: +39-333-4460720 (M.C.)
| | - Massimo Marignani
- UOC Malattie Apparato Digerente e Fegato, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy;
- Correspondence: (M.C.); (M.M.); Tel.: +39-333-4460720 (M.C.)
| | - Maria Laura Sorgi
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Paola Begini
- UOC Malattie Apparato Digerente e Fegato, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy;
| | - Michela Ileen Biondo
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Sara Caporuscio
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Vincenzo Colonna
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Francesca Della Casa
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Paola Conigliaro
- UOC di Reumatologia, Dipartimento di “Medicina dei Sistemi”, Università di Tor Vergata, 00133 Roma, Italy;
| | - Cinzia Marrese
- Ambulatorio di Reumatologia, ASL Roma 1, Presidio Nuovo Regina Margherita, 00153 Roma, Italy;
| | - Eleonora Celletti
- Istituto di Clinica Medica, ASL Lanciano-Vasto-Chieti, 66100 Chieti, Italy;
| | - Irene Modesto
- Unità Operativa di Medicina Interna, Università degli Studi di Palermo, AO Ospedali Riuniti Villa Sofia-Cervello, PO Vincenzo Cervello, 90146 Palermo, Italy;
| | | | - Bruno Laganà
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Andrea Picchianti-Diamanti
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Roberta Di Rosa
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Claudia Ferlito
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Simonetta Salemi
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Raffaele D’Amelio
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy;
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Reactivation of Hepatitis B Virus in Patients with Multiple Myeloma. Cancers (Basel) 2019; 11:cancers11111819. [PMID: 31752356 PMCID: PMC6895787 DOI: 10.3390/cancers11111819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022] Open
Abstract
Reactivation of hepatitis B virus (HBV) is a well-known complication in patients with hematological malignancies during or after cytotoxic chemotherapy. If the initiation of antiviral therapy is delayed in patients with HBV reactivation, these patients can develop severe hepatitis and may die of fulminant hepatitis. The preventive strategy for HBV reactivation in patients with malignant lymphoma has already been established based on some prospective studies. As there was an increased number of novel agents being approved for the treatment of multiple myeloma (MM), the number of reported cases of HBV reactivation among MM patients has gradually increased. We conducted a Japanese nationwide retrospective study and revealed that HBV reactivation in MM patients is not rare and that autologous stem cell transplantation is a significant risk factor. In this study, around 20% of all patients with HBV reactivation developed HBV reactivation after 2 years from the initiation of therapy, unlike malignant lymphoma. This might be due to the fact that almost all of the patients received chemotherapy for a long duration. Therefore, a new strategy for the prevention of HBV reactivation in MM patients is required.
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