Late onset of hepatitis B virus reactivation following hematopoietic stem cell transplantation: successful treatment with combined entecavir plus tenofovir therapy

Abstract

Prophylaxis with lamivudine (LAM) is recommended for hepatitis B core antibody-positive allogenic hematopoietic stem cell transplant (HSCT) recipients, but the optimal timing for the institution and duration of the prophylaxis is still unknown. Furthermore, considering the high rate of mortality associated with hepatitis B virus reactivation (HBV-R), the most potent and long-term effective antiviral regimen should be considered. We report here a case of late onset of HBV-R after a long-term prophylaxis with LAM in a patient who underwent HSCT for non-Hodgkin lymphoma and who was successfully treated with a combination antiviral regimen including entecavir and tenofovir disoproxil fumarate.

Management of severe acute to fulminant hepatitis B: to treat or not to treat or when to treat?

“…On the contrary, more data concerning the two newer antivirals entecavir and tenofovir has been published in cases with severe acute reactivation of chronic or occult HBV infection after immunosuppression or chemotherapy, a situation which is similar enough with that of the "naïve" acute severe to fulminant hepatitis B (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). In these studies the treatment was started as rescue therapy after exacerbation of chronic or occult hepatitis B and particularly in those who had received rituximab-based regimen, with favourable outcome in most of the affected cases (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). It should be noted, however, that not all of these patients with HBV reactivation suffered from severe hepatic failure as defined above (38)(39)(40), while several difficulties of managing severe HBV reactivation are still present (e.g.…”

“…The most solid data are indeed published for lamivudine whereas the same level of evidence to demonstrate safety in severe acute hepatitis B is not yet available for entecavir or tenofovir as these newer more potent antivirals have become available more recently. However, existing evidence shows that entecavir and tenofovir are efficient in a similar situations as the acute, severe reactivation of overt or occult HBV infection (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78), but still toxicity with entecavir or tenofovir cannot be excluded at the same level of certainty (81,82). Overall, we can suggest that lamivudine or the more potent antivirals could be used by the hepatologists if they must treat cases with severe acute hepatitis B.…”

Efficacy and tolerability of Entecavir for hepatitis B virus infection after hematopoietic stem cell transplantation

“…Furthermore, ETV showed a low resistance rate compared with LAM (Tenney et al 2009). Recent case reports have described successful treatment of HBV reactivation after HSCT with ETV (Christopeit et al 2010; Milazzo et al 2011). Therefore, ETV is a strong candidate as a substitute for LAM for HBV prophylaxis in HSCT.…”

Hepatitis B serological changes following allogeneic bone marrow transplantation

“…In recent years, the number of reported cases of RS of HBV following allo‐HSCT in patients with serological evidence of past infection has steadily increased, with the rates ranging from 14% to 86% in studies with longer duration of follow‐up, and is also partly influenced by the prevalence of donor antiHBsAb . RS is usually preceded by a decline in antiHBsAb below the protective threshold post transplantation , although new risk factors have been recently identified including type of hematological disease and duration of immunosuppression .…”