Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

Abstract

in the setting of chemotherapy and immunosuppression may lead to fulminant liver failure and death, but there is a cumulative body of evidence that these are potentially preventable adverse outcomes. As chronic hepatitis B is largely asymptomatic but also endemic worldwide, clinicians caring for patients requiring chemotherapy or immunosuppression need to be vigilant of the potential for HBVr in susceptible individuals. Serological screening and prophylactic and pre-emptive antiviral treatment with a nucleos(t)ide analogue should be considered in appropriate settings. Hepatitis B prevalence is examined in this review article, as are the risks of HBVr in patients receiving chemo-and immunosuppressive therapy. Recommendations regarding screening, monitoring and the role of antiviral prophylaxis are outlined with reference to current international associations' guidelines and the best available evidence to date. AbstractDue to the inherent relationship between the immune system and the hepatitis B virus (HBV) in exposed and infected individuals, immunomodulation associated with the treatment of solid tumours, haematological malignancies and inflammatory disorders has been linked to HBV reactivation (HBVr). Reactivation of HBV infection REVIEWSubmit a

A diffúz nagy B-sejtes lymphoma modern szemlélete és kezelése

“…Amennyiben felmerül hepatitis B-fertőzés (HBsAg-pozitív vagy anti-HBc-pozitív), akkor antivirális profilaxist kell alkalmazni [23]. A vírus-DNS monitorozása is javasolt alacsony rizikó esetén, de ÖSSZEFOGLALÓ KÖZLEMÉNY bizonyítottan nem annyira hatásos a kezelés elkezdése emelkedő vírustiter esetén, mint ha profilaxist kapott volna a beteg [23]. A hepatitis C-pozitív esetekben szintén indokolt vírus-RNS-PCR, de a reaktiváció veszélye C-vírus esetén nem annyira jelentős.…”

Hepatitis B Reactivation in Immunosupressed Patients, Prophylaxis and Management

“…The rate of hepatitis B virus reactivation events in the setting of chronic airways disease due to chronic oral vs. inhaled steroid use is 11.1% and 3.2%, respectively. 9 The magnitude of risk of hepatitis B virus reactivation Ulfa Kholili, Tri Yanti…”

“…For instance, rituximab, is an agent predominantly used to treat haematological malignancy in addition to autoimmune and neurological disease. 9,10 Rituximab is an agent that works against CD20 on B-cell. CD20 positive B-cells depletion might reduce the number of CD4 memory cells, CD8 cells, and antibody-mediated immunity.…”

Spontaneous hepatitis B surface antigen seroconversion after long lasting hepatitis B virus infection in a chronic hemodialysis patient

“…Corticosteroids are the most longstanding and hence most commonly used of the immunosuppressants. In addition to their effect on T-cell function, corticosteroids directly enhance HBV replication through the interaction with the HBV glucocorticoid responsive element (a transcriptional regulatory element) [25][26] . Although steroids are administered at a range of dosages and durations for a variety of indications, it has been observed that a 4-week course of prednisone in a dosage higher than 20 mg has been associated with high risk (> 10 %) of HBV reactivation in the post-withdrawal (immune reconstitution) phase and worsened liver histology [26][27] .…”

“…In addition to their effect on T-cell function, corticosteroids directly enhance HBV replication through the interaction with the HBV glucocorticoid responsive element (a transcriptional regulatory element) [25][26] . Although steroids are administered at a range of dosages and durations for a variety of indications, it has been observed that a 4-week course of prednisone in a dosage higher than 20 mg has been associated with high risk (> 10 %) of HBV reactivation in the post-withdrawal (immune reconstitution) phase and worsened liver histology [26][27] . Our patient was on the constant IS therapy with prednisone (dosage of 30 mg per day and more for more than initial month after TX and 5 mg daily from the sixth month after TX and ongoing), from 2008 until 2017, during a span of 9 years, and HBV reactivation has not occurred yet.…”