Hepatitis B in patients with hematological diseases: An update

Abstract

Hepatitis B virus (HBV) reactivation (HBVr) in patients undergoing immunosuppressive therapy is still a hot topic worldwide. Its prevention and management still represents a challenge for specialists dealing with immunosuppressed patients. Aim of this paper is to provide a critical review of the relevant information emerged in the recent literature regarding HBV reactivation following immunosuppressive treatments for oncohematological tumors. A computerized literature search in MEDLINE was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. Articles published only in abstract form and case reports not giving considerable news were excluded. Clinical manifestation of HBVr can be manifold, ranging from asymptomatic self-limiting anicteric hepatitis to life-threatening fulminant liver failure. In clusters of patients adverse outcomes are potentially predictable. Clinicians should be aware of the inherent risk of HBVr among the different virological categories (active carriers, occult HBV carriers and inactive carriers, the most intriguing category), and classes of immunosuppressive drugs. We recommend that patients undergoing immunosuppressive treatments for hematological malignancies should undergo HBV screening. In case of serological sign(s) of current or past infection with the virus, appropriate therapeutic or preventive strategies are suggested, according to both virological categories, risk of HBVr by immunosuppressive drugs and liver status. Either antiviral drug management and surveillance and pre-emptive approach are examined, commenting the current international recommendations about this debated issue.

Guideline for the treatment of chronic lymphocytic leukaemia

“…All patients should be screened for evidence of prior hepatitis B or C infection prior to therapy. Reactivation of viral hepatitis has been described following fludarabine, bendamustine, anti‐CD20 therapy and, BTKi (Coluccio et al , ; Herishanu et al , ). CLL patients with evidence of prior infection should be managed jointly with a specialist hepatologist (Hallek et al , ; Hwang et al , ).…”

Reactivation of Hepatitis B Virus Infection 66 months after Rituximab Therapy For Chronic Lymphocytic Leukemia, Emphasis on Interplay between Infection, Drugs and Disease Biology

“…In normal population, after the entrance of HBV virus, the outcomes may be either; 1. infection may be rapidly eliminated, most expectedly in an immunocompetent individual, or 2. viral DNA may integrate in the hepatocyte and persist indefinitely but in a state that replication is minimally active but under control and last, 3. host immune system may be unable to eradicate or control the infection and this condition leads to chronic liver disease. As a result of these mechanisms, patients present with certain laboratory features which are defined as AC, OBI or IC a.k.a "low replicative chronic HBV infection" (1). When a hematological malignancy is included in the picture, the immunologic pathways are altered due to reasons such as, the disease biology and as well as the treatments used for this malignancy and their short term and long term consequences.…”

“…Hepatitis B virus (HBV) reactivation (HBVr) in patients receiving immunosuppression is an evolving topic. Terminology of HBV status include active carrier (AC) who are HbsAg positive with elevated HBVDNA (>2000IU/mL), occult HBV carrier (OBI) who are HbsAg negative but Anti HBc positive with absent HBVDNA and positive or negative AntiHBs, inactive carrier (IC) HbsAg positive but HBVDNA is absent or <2000IU/mL (1). American Gastroenterology Association (AGA) have reported a guideline for the management of patients with certain HBV status who will undergo immunosuppression with regard to patients' HBV status as well as the category and duration of immunosuppression Prior to immunosuppressive treatments, all patients should be screened for HBV with HbsAg, AntiHBs, and AntiHBc (2).…”

Bushen recipe and its disassembled prescriptions inhibit inflammation of liver injury associated with Concanavalin A through Toll‑like receptor 3/9 signaling pathway

“…Hepatitis B has become one of the most prevalent and serious infectious diseases in the world and persistently infects 350 million people worldwide with the added risk of development of other chronic liver diseases (20)(21)(22). It not only seriously affects human health, but it also brings a vast economic burden to patients and society.…”