Hepatitis B Virus Reactivation in Patients Undergoing Chemoimmunotherapy for Haematological Malignancies

Abstract

Hepatitis B virus (HBV) infection continues to be a major global health problem. HBV reactivation has been documented both in HBsAg positive patients and in individuals with occult hepatitis B infection (OBI)-negative for HBsAg but positive for anti-hepatitis B core IgG antibodies (IgG anti-HBc). HBV reactivation has a major clinical significance, especially in patients receiving chemoimmunotherapy for haematological malignancies (HM). We aimed to evaluate clinical and epidemiological patterns of HBV reactivation in the OBI group compared to the HBV reactivation in HBsAg positive patients (non-OBI group) during chemoimmunotherapy for HM. We enrolled 63 patients with HM and at least one serological marker of HBV infection, including 10 patients with OBI. Viral reactivation occurred overall in 29/63 patients (46.2%). In the OBI group, seven patients (70%) had reactivation with HBsAg reverse seroconversion after a mean of 5.5 chemotherapy cycles, compared to 22 patients (41.5%) in the non-OBI group (p = 0.0097). All patients with viral reactivation were treated with antiviral therapy (entecavir) with a favourable outcome. No deaths occurred due to hepatic failure and the risk of reactivation was not correlated with age, sex and type of HM in our patients. Rezumat Infecția cu virus hepatitic B (VHB) continuă să reprezinte o problemă majoră de sănătate publică la nivel mondial. Reactivarea infecției VHB a fost observată atât la pacienții AgHBs pozitivi, cât și la cei cu AgHBs negativ dar care prezentau anticorpi anti-HBc IgG (OBI). Reactivarea infecției VHB are o mare importanță clinică, mai ales la persoanele aflate sub chimioimunoterapie pentru hemopatii maligne (HM). Studiul de față a avut ca obiectiv evaluarea caracteristicilor clinice și epidemiologice ale reactivării infecției VHB la pacienții cu OBI comparativ cu pacienții cu AgHBs pozitiv (non-OBI) în timpul chimio-imunoterapiei pentru HM. Lotul a cuprins 63 pacienți care aveau cel puțin un marker serologic pozitiv pentru VHB, dintre care 10 pacienți au avut OBI. În ansamblul lotului de studiu, reactivarea virală a fost observată în 29/63 cazuri (46,2%). În grupul OBI reactivarea virală VHB a fost identificată la 7 pacienți (70%) care au prezentat revers seroconversie AgHBs în medie după 5,5 cicluri chimioterapice, față de 22 cazuri (41,5%) în grupul non-OBI (p = 0,0097). Toți pacienții cu reactivare virală VHB au primit tratament antiviral cu entecavir și au avut o evoluție favorabilă. Nu s-a înregistrat nici un deces datorat insuficienței hepatice, iar riscul de reactivare nu s-a corelat cu vârsta, sexul sau tipul histologic al afecțiunii hematologice la pacienții aflati în studiu.

Reduced Bone Mineral Density in Young, Non-Cirrhotic Patients With Chronic Viral Hepatitis

“…In a recent research, patients with reactivation of hepatitis B in condition of chemo-immunotherapy for haematological malignancies were treated with entecavir and they had a favourable outcome [19], and that may slow the demineralization rate. Toxic hepatitis may also have a role in bone demineralization, especially if some drugs that are administrated in a period large enough so that the demineralization may occur.…”

“…The estimated global prevalence of chronic viral hepatitis in 2018 was of 257 million for hepatitis B virus (HBV) and 71 million for hepatitis C virus (HCV), thus reinforcing their position as a major health concern both among physicians and researchers [19,20]. Considering the substantial progress that has been made in effectively treating viral hepatitis, we are now facing the challenges of long-term management of these patients and the complications caused by the extensive course of their liver disease.…”