Real-world prevalence of hepatitis B virus reactivation in cancer patients in Taiwan

Abstract

Background Hepatitis B virus carriers who receive systemic cancer chemotherapy have been found to be at a higher risk of hepatitis B virus reactivation. However, lack of standard prophylaxis protocol resulted in life-threatening adverse events. Objective This retrospective study is to investigate prevalence and chemotherapy drug-induced hepatitis B virus reactivation in all types of cancer patients and establish an institutional clinical practice protocol. Methodology: This retrospective cohort study evaluated the incidence of hepatitis B virus infection, the pre-chemotherapy screening rate of hepatitis B surface antigen (HBsAg), and the severity of hepatitis B virus reactivation of cancer patients receiving intravenous chemotherapy between 2013 and 2014. Patients receiving local chemotherapy with intra-cavity instillation, drug- or alcohol-related hepatitis, or chemotherapy for immune diseases were excluded. Results In total 784 patients, 404 patients (51.53%) underwent hepatitis B virus serum antigen (HBsAg) testing before chemotherapy, and 61 patients (7.78%) tested positive. Only 32 patients (4.08%) received prophylactic hepatitis B virus antiviral therapy. Patients receiving prophylactic antiviral drugs were significantly lower risk of hepatitis B virus reactivation than nonprophylaxis (relative risk, RR: 0.53, number needed to treat, NNT: 12). Moreover, our study found specific single or combined chemotherapy that may cause hepatitis B virus reactivation different from those of other studies conducted in Western countries. The differences may refer to enzymes, proteins and immune response of patients. Conclusions Our findings indicate that cancer patients receiving prophylactic antiviral drugs remain at risk of hepatitis B virus reactivation during chemotherapy. Therefore, the hepatitis B virus screen and chemotherapy control system was established in 2017 to reduce the risk of hepatitis B virus reactivation and improve patient safety.

Screening for viral hepatitis B infection in cancer patients before receiving chemotherapy – A systematic review and meta‐analysis

“…The studies reported hematologic malignancy (10 studies), [27][28][29][30]34,41,43,45,48,54 solid malignancy (four studies), 31,44,47,50 or a combination of both (15 studies). 26,32,33,[35][36][37][38][39][40]42,46,49,[51][52][53] The studies also included rituximab-containing (seven studies), 27,28,30,34,41,43,54 non-rituximab (four studies), 31,42,44,46 or both regimens (seven studies), 32,33,36,38,40,48,49 and the remaining 11 studies did not specify chemotherapy types. 26,29,34,…”

“…26,32,33,[35][36][37][38][39][40]42,46,49,[51][52][53] The studies also included rituximab-containing (seven studies), 27,28,30,34,41,43,54 non-rituximab (four studies), 31,42,44,46 or both regimens (seven studies), 32,33,36,38,40,48,49 and the remaining 11 studies did not specify chemotherapy types. 26,29,34,37,38,45,47,[50][51][52][53] Nineteen studies 27,28,[32][33][34][35][36]…”

“…26,[29][30][31]37,41,45,47,51,53 Most studies (n = 17) originated from Asia (n = 4 from Australia and Taiwan, n = 3 from Japan, n = 2 from Turkey and China, and n = 1 from Thailand and Singapore), while the other 11 studies were conducted in the United States and only one in Spain (Figure 2). HBV endemicity was classified as low endemic in 19 studies, [32][33][34][35]38,39,[40][41][42][43]45,46,48,49,51 lower intermediate endemic in four studies, 31,47,50,54 higher intermediate endemic in four studies, 36,44,52,53 and high endemic in two studies. 37,39 To analyze the trend in screening rates over time, the studies were categorized into three 5-year periods: 13 studies from 2006 to 2010, [26][27][28][31][32][33][34]36,[40][41]…”

“…HBV endemicity was classified as low endemic in 19 studies, [32][33][34][35]38,39,[40][41][42][43]45,46,48,49,51 lower intermediate endemic in four studies, 31,47,50,54 higher intermediate endemic in four studies, 36,44,52,53 and high endemic in two studies. 37,39 To analyze the trend in screening rates over time, the studies were categorized into three 5-year periods: 13 studies from 2006 to 2010, [26][27][28][31][32][33][34]36,[40][41][42]50,54 19 studies from 2011 to 2015, 29,30,33,35,[37][38][39][40]42,43,[45]…”

“…37,39 To analyze the trend in screening rates over time, the studies were categorized into three 5-year periods: 13 studies from 2006 to 2010, [26][27][28][31][32][33][34]36,[40][41][42]50,54 19 studies from 2011 to 2015, 29,30,33,35,[37][38][39][40]42,43,[45][46][47]49,50,[52][53][54] and five studies from 2016 to 2020. 44,48,50,51,53 Regarding quality assessment, 25 studies were considered as good quality, and the other four studies were evaluated as fair quality by reason of inadequacy of follow-up time for the outcome to occur and no statement about the follow-up of subjects (Table S1).…”