Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Sagnelli, Evangelista; Pisaturo, M.; Martini, Salvatore; Filippini, Pietro; Coppola, Nicola

doi:10.4254/wjh.v6.i6.384

Cited by 58 publications

(64 citation statements)

References 116 publications

(143 reference statements)

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“…HBVr in patients undergoing ISDT is a life-threatening event described in both HBsAg-positive patients (overt HBV infection) [9] and HBsAgnegative but anti-HBc-positive patients (past HBV ifection). Actually is consider as moderate/high risk of HBVr, in patients with breast cancer, the treatment based on derivatives of anthracyclines such as doxorubicin and epirubicin.…”

Section: Discussionmentioning

confidence: 99%

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

Fiore¹,

Crosato²,

Bussani³

et al. 2016

Journal of Gastroenterology and Hepatology Research

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Reactivation of hepatitis B virus (HBV) is a well-recognized complication following immunosuppressive drug therapy in patients with past infection. The International Guidelines for HBV screening before cytotoxic or immunosuppressive therapy are controversial, there is only agreement on the use of biological agent such as anti-CD 20. The literature data do not report HBV reactivation due to capecitabine and therefore the international guidelines do not recommend prophylaxis in that condition. In this paper, we describe the history of HBV reactivation of hepatitis B in a female patient with breast cancer treated using capecitabine observed in a Unit of Infectious Diseases of north-est of Italy.

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Section: Discussionmentioning

confidence: 99%

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

Fiore¹,

Crosato²,

Bussani³

et al. 2016

Journal of Gastroenterology and Hepatology Research

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“…Ayrıca Hepatit B immünglobulin ve lamivudin tedavisi alan nakil sonrası dönemde HBsAg'si negatifleşen HBsAg pozitif organ alıcılarında da OBİ gelişebildiği rapor edilmektedir (64,65). (66)(67)(68). İmmün aracılı enflamatuvar hastalığı nedeniyle monoklonal anti-TNF-α (tumor necrosis factor alpha) ve yüksek doz stereoid tedavisi alan romatoloji hastaları ile solid organ tümörleri nedeniyle kemoterapi/radyoterapi alan hastalarda, aşikar HBV reaktivasyonlarına daha sık rastlanılmasına ve anti-HBV profilaksisi uygulanabilmesine karşın, bu hasta gruplarında araştırılan ve/ya rapor edilen OBİ reaktivasyonları sıklığı henüz net olarak bilinmemektedir (66).…”

Section: Bulaşma Riskiunclassified

“…(66)(67)(68). İmmün aracılı enflamatuvar hastalığı nedeniyle monoklonal anti-TNF-α (tumor necrosis factor alpha) ve yüksek doz stereoid tedavisi alan romatoloji hastaları ile solid organ tümörleri nedeniyle kemoterapi/radyoterapi alan hastalarda, aşikar HBV reaktivasyonlarına daha sık rastlanılmasına ve anti-HBV profilaksisi uygulanabilmesine karşın, bu hasta gruplarında araştırılan ve/ya rapor edilen OBİ reaktivasyonları sıklığı henüz net olarak bilinmemektedir (66). Ayrıca belirtmek gerekir ki histon deasetilaz inhibitörlerinin OBİ reaktivasyonları ile ilişkili olduğuna dair veriler, HBV reaktivasyonunun kontrolünde viral cccDNA minikromozomunun yapı ve dinamiğini etkileyen epigenetik modifikasyonların rolüne ilişkin indirekt kanıtları oluşturmaktadır.…”

Section: Bulaşma Riskiunclassified

Okült Hepati̇t B Vi̇rus Enfeksi̇yonu: Moleküler Mekani̇zmalar Ve Kli̇ni̇k Önemi̇

Çakal

2017

İstanbul Tıp Fakültesi Dergisi

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Occult Hepatitis B Virus (HBV) infection (OBI) is defined as the long-lasting persistence of HBV genomes in the hepatocytes of individuals testing negative for HBV surface antigen (HBsAg) by currently available assays and usually for serum HBV DNA. OBI is considered as the possible phase in the natural history of chronic HBV infection that the host's immune surveillance and epigenetic mechanisms are likely involved. Clinical impact of OB is that it can be transmitted (i.e., through blood transfusion, by liver organ transplantation, hemodialysis and parturition) causing classic forms of hepatitis B in newly infected individuals. The development of an immunosuppressive status may induce OBI reactivation and development of acute and often severe hepatitis. OBI can favor the progression of liver fibrosis. Also OBİ infection has been hypothesized to be a significant risk factor contributing to the progression of chronic liver diseases (CLD) with increased risk for hepatocellular carcinoma (HCC) which may lead to an increased progression of liver diseases. Although OBI is considered a phase in the natural history of HBV, the molecular mechanisms leading to its occurrence and its contribution to HCC development are yet poorly understood. In this review, it is aimed to examine clinical importance, epidemiological aspects and laboratory diagnosis of OBI in recent literature.

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“…Excepting rituximab, there is no evidence for systematic antiviral prophylaxis in resolved or OBI in patients on immunosuppresants, taking into account that the HBV reactivation occurs rarely [78] . These patients must be followed closely during therapy (every 13 mo, and for 6 mo after stopping treatment), and considered for prophylactic therapy according to DNA levels [5] (Figure 1).…”

Section: Prophylaxis In Hepatitis B Resolved Infectionmentioning

confidence: 99%

“…Tenofovir and entecavir have a higher barrier to resistance, and should be used if treatments longer than 12 mo are planned [6,76,77,82,83] . In those patients with OBI with a high risk of reactivation, lamivudine may still have a role, because of its low cost, and the low or absent HBV viremia in these cases [76,78] . Alternative antiviral medications for lamivudine would be adefovir and telbivudine [20] .…”

Section: Which Antiviral Drug Must We Choose?mentioning

confidence: 99%

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

López-Serrano

Briongos

Alonso

et al. 2015

WJH

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Currently immunosuppressive and biological agents are used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus (HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapyCore tip: Few reviews have been published including data of the three more common inflammatory diseases that require immunosuppressive therapy: inflammatory bowel disease, rheumatic and dermatologic diseases. This paper is focused on the risk of reactivation of hepatitis B virus under immunosuppressants, and particularly corticosteroids. Although most of the guidelines do not specify the necessity of prophylaxis in case of monotherapy with corticosteroids, the specialists responsible of these patients are usually concerned about this issue. Moreover, the risk with low systemic bioavailability new corticosteroids has not been evaluated in previous reviews. This work summarizes the evidence of VHB reactivation in patients with inflammatory diseases: when and how to apply prophylaxis, with a special focus on "new" and "old" steroids.López-Serrano P, de la Fuente Briongos E, Carrera-Alonso E, Pérez-Calle JL, Fernández Rodríguez C. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy.

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Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Cited by 58 publications

References 116 publications

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

Okült Hepati̇t B Vi̇rus Enfeksi̇yonu: Moleküler Mekani̇zmalar Ve Kli̇ni̇k Önemi̇

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

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