Viral Hepatitis: Manifestations and Management Strategy

Abstract

Viral hepatitis is the third most common cause of liver disease in allogeneic transplant recipients and causes significant morbidity and mortality. When treating patients with hematological malignancies, an emphasis should be placed on identification of patients at risk for viral hepatitis with appropriate screening. Initial screening serology should include anti-HCV, HBsAg, anti-HBs, and anti-HBc testing. When hepatitis B exposure has been documented, prophylaxis of viral reactivation for all HBsAg-positive patients with a nucleoside analogue should be implemented. HCV infection appears to have little short-term impact on survival after bone marrow transplantation, but is a risk factor for veno-occlusive disease (VOD) and graftversus-host disease (GVHD). In the long-term survivor, HCV infection can lead to significant morbidity and mortality due to the development of cirrhosis, decompensation, and liver cancer. Since effective antiviral therapies are available for both hepatitis B and C, routine screening and selected intervention is recommended once reactivation and disease recurrence is documented. In this chapter we will highlight the mechanisms of virus reactivation, clinical manifestations, and management strategies to minimize acute and chronic morbidity in this population.

Viral infection and reactivation in autoimmune disease

“…Although it is known that immunosuppression enhances HCV replication, chronic HCV infection appears to be less commonly associated with reactivation than has been observed after infection with HBV (46). There have been only isolated case reports of reactivation of HCV associated with immunosuppressive therapy in patients with autoimmune diseases (47).…”

Effects of E‐cadherin (CDH1) gene promoter polymorphisms on the risk and clinicopathological development of hepatocellular carcinoma

“…The carcinogenesis of HCC is a multifactor, multistep, complex process. Previous research shows that multiple risk factors contribute to hepatocarcinogenesis: chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, cirrhosis, carcinogen exposure, excessive alcohol consumption, and a variety of genetic factors [3][4][5]. Epidemiological studies indicate that both environmental and genetic factors mediate an individual's susceptibility to cancer; i.e., inherited mutations or alterations in certain genes could make individuals more or less susceptible to developing certain cancers.…”

Allogeneic hematopoietic cell transplant in HCV-infected patients

“…Nevertheless, marked bile duct injury with epithelial cell drop-out and loss of interlobular bile ducts are more typical of GVHD [12,28,29]. After three months, the occurrence of late hepatitis is possible, which coincides with a decrease in or discontinuation of immunosuppressive therapy and a return of cellular immunity [12,13,26,30,31]. The most difficult situation at this time is the unusual presentation of liver GVHD (hepatic Variant), resembling viral hepatitis [32,33], also described after donor lymphocyte infusion [34], in which liver biopsy is essential to confirm GVHD.…”