Reactivation of hepatitis B virus infection in patients with hematologic disorders

Abstract

Hepatitis B reactivation is the reappearance or rise of hepatitis B virus (HBV) DNA in patients with past or chronic HBV infection, usually occurring in the context of immunosuppression. HBV reactivation has been most commonly reported in patients with hematologic disorders, with potentially serious and life-threatening consequences. In this review, we discuss the basis and presentation of HBV reactivation, and risk factors in terms of the host, the virus and the immunosuppression regimen, including newer agents used to manage hematologic malignancies. We overview the management of HBV reactivation, highlighting an up-dated recommendation on the use of newer nucleoside and nucleotide analogs, such as tenofovir and entecavir, for antiviral prophylaxis.

Prevention of hepatitis B virus reactivation in patients with hematological malignancies and resolved hepatitis B virus infection: a systematic review and meta‐analysis

“…The small molecule Bruton's tyrosine kinase (BTK) inhibitors, for example, ibrutinib, have shown promising results in the treatment of lymphoma and chronic lymphocytic leukemia . These agents block B‐cell antigen receptor signaling, which prevents the growth of malignant B cells and induces apoptosis . Another mechanism of ibrutinib involves restoring the dysregulated T‐cell response that occurs in B‐cell malignancies by inhibiting the T helper 2 (Th2)‐polarized response and causing the compensatory activation of Th1 cells and cytotoxic T‐lymphocytes.…”

“…HBV reactivation is a significant risk in patients who have a previous HBV infection and who require chemotherapy for hematological malignancies or are undergoing hematopoietic stem cell transplants (HSCT). [1][2][3][4][5][6] After the resolution of an acute HBV infection, small amounts of HBV DNA can remain in the liver, even if the DNA is no longer detectable in peripheral blood. The residual virus is controlled by innate immunity, but if the patient's immune system becomes suppressed (eg, during chemotherapy), the latent HBV in the hepatocytes begins to replicate rapidly.…”

“…Outcome data were considered to be complete and there was no selective reporting. The average NOS score for the other 11 included studies was 6.18 (range [4][5][6][7][8][9]. Most of the studies were considered to be of intermediate to high quality (Table S2).…”

“…The risk of reactivation depends on the underlying disease, types of treatment and host factors. HBV reactivation is a significant risk in patients who have a previous HBV infection and who require chemotherapy for hematological malignancies or are undergoing hematopoietic stem cell transplants (HSCT) . After the resolution of an acute HBV infection, small amounts of HBV DNA can remain in the liver, even if the DNA is no longer detectable in peripheral blood.…”

Reactivation of Hepatitis B Virus in Cancer Patients Receiving Chemotherapy

“…Similarly many studies have shown that adriamycin-based chemotherapy and steroids have shown an increased incidence of reactivation of HBV. 11 Most of the reactivation occurs between the second and fourth cycle of chemotherapy. There are few studies which showed late reactivation of hepatitis B virus even after completion of chemotherapy, but in our study none of the patients got reactivated after 3 months of follow up, but a longer term of follow up must be needed.…”