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Review
. 2012 Nov;20(11):2999-3008.
doi: 10.1007/s00520-012-1576-7. Epub 2012 Aug 30.

Hepatitis B virus management to prevent reactivation after chemotherapy: a review

Jessica P Hwang  1 , John M Vierling, Andrew D Zelenetz, Susan C Lackey, Rohit Loomba
Affiliations
Review

Hepatitis B virus management to prevent reactivation after chemotherapy: a review

Jessica P Hwang et al. Support Care Cancer. 2012 Nov.

Erratum in

  • Support Care Cancer. 2013 Apr;21(4):1211

Abstract

Purpose: Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy.

Methods: We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library.

Results: Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests-HBsAg, anti-HBc, and anti-HBs-allows the most thorough interpretation of a patient's serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies.

Conclusions: Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.

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Conflict of interest statement

Conflict of interest disclosures Drs. Hwang, Vierling, Zelenetz, and Loomba served on an Advisory Board for reactivation of HBV infection for Gilead Sciences. Dr. Hwang has received research support from Bristol-Myers Squibb. Dr. Vierling has received research support from and serves as a Scientific Advisor for Gilead Sciences, Bristol-Myers Squibb, Roche, and Merck. Dr. Zelenetz serves as a Scientific Advisor for Gilead Sciences, Roche/Genentech, and GlaxoSmithKline. Dr. Loomba has received research support from Daiichi Sankyo and is a Scientific Advisor for Gilead Sciences and Gene Probe.

References

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