Reactivation of hepatitis B virus infection in patients with hemo-lymphoproliferative diseases, and its prevention

Abstract

Reactivation of hepatitis B virus (HBV) replication is characterized by increased HBV-DNA serum values of about 1 log or by HBV DNA turning positive if previously undetectable in serum, possibly associated with liver damage and seldom life-threatening. Due to HBV reactivation, hepatitis B surface antigen (HBsAg)-negative/anti-HBc-positive subjects may revert to HBsAg-positive. In patients with hemo-lymphoproliferative disease, the frequency of HBV reactivation depends on the type of lymphoproliferative disorder, the individual's HBV serological status and the potency and duration of immunosuppression. In particular, it occurs in 10%-50% of the HBsAg-positive and in 2%-25% of the HBsAg- negative/anti-HBc-positive, the highest incidences being registered in patients receiving rituximab-based therapy. HBV reactivation can be prevented by accurate screening of patients at risk and by a pharmacological prophylaxis with anti-HBV nucleo(t)sides starting 2-3 wk before the beginning of immunosuppressive treatment and covering the entire period of administration of immunosuppressive drugs and a long subsequent period, the duration of which depends substantially on the degree of immunodepression achieved. Patients with significant HBV replication before immunosuppressive therapy should receive anti-HBV nucleo(t)sides as a long-term (may be life-long) treatment. This review article is mainly directed to doctors engaged every day in the treatment of patients with onco-lymphoproliferative diseases, so that they can broaden their knowledge on HBV infection and on its reactivation induced by the drugs with high immunosuppressive potential that they use in the care of their patients.

Severe early hepatitis B reactivation in a patient receiving anti-CD19 and anti-CD22 CAR T cells for the treatment of diffuse large B-cell lymphoma

“…The reactivation of HBV is a well-known complication in patients undergoing chemotherapy or immunosuppressive therapy for hematologic malignancies, particularly in the event of stem cell transplantation or when using monoclonal antibodies against the CD20 protein, which is found on the surface of immune system B cells, such as rituximab [7–10]. The reactivation of HBV is defined as a more than 10-fold increase in HBV-DNA, the detection of HBV-DNA in a patient who previously had undetectable HBV-DNA, or when reverse seroconversion occurs with liver damage, which is seldom life-threatening [11]. Guidelines suggest that antiviral prophylaxis should be initiated at least 1 week before or when starting chemotherapy.…”

An estimation of the prevalence of occult HBV infection in Western Europe and in Northern America: A meta‐analysis

“…However, the data on the prevalence of OBI are very few. Although in Western Europe and in Northern America the prevalence of HBV infection, and probably of OBI, is lower than that observed in other regions such as sub‐Saharan Africa and in Asia, in these countries the immunosuppressive therapies at higher risk of reactivation of occult HBV infection are widely used . Thus, the knowledge on the prevalence of OBI in Western Europe and in Northern America would have an important clinical significance.…”

Cancer- and non-cancer related chronic pain: from the physiopathological basics to management

“…All patients were evaluated for HBV, and HCV serum markers. Serum samples were tested for HBsAg, anti-HCV, total anti-HBc, and anti-hepatitis B surface antibody (HBs) using commercial immunoenzymatic assays (Abbott Laboratories, North Chicago, IL, USA: AxSYM® HBsAg (v2) M/S for HBsAg, AxSYM® HCV (v3) for anti-HCV, AxSYM® CORE™ (v2) for total anti-HBc, and AxSYM® AUSAB® for anti-HBs), as described in previous studies [20, 21, 22, 23, 24, 25, 26, 27, 28].…”