Management of hepatitis B reactivation in patients receiving cancer chemotherapy

Abstract

Hepatitis B virus (HBV) reactivation is well documented in previously resolved or inactive HBV carriers who receive cancer chemotherapy. The consequences of HBV reactivation range from self-limited conditions to fulminant hepatic failure and death. HBV reactivation also leads to premature termination of chemotherapy or delay in treatment schedules. This review summarizes current knowledge of management of HBV reactivation in patients receiving cancer chemotherapy. HBV surface antigen (HBsAg) testing should be performed in patients who require cancer chemotherapy. Four meta-analyses support lamivudine prophylaxis for HBV reactivation during chemotherapy in HBsAg-positive patients. Randomized controlled trials to compare different HBV antiviral agents are needed to define optimal regimens for the prevention and treatment of HBV reactivation in patients receiving cancer chemotherapy.

Keywords: HBV reactivation; cancer; chemotherapy; hepatitis B virus; lamivudine; prophylaxis.

Figure 1.

Typical clinical course of HBV reactivation in HBsAg-positive and HBsAg-negative/anti-HBc-positive individuals receiving chemotherapy. In HBsAg-positive patients, serum HBV DNA was undetectable at the time of peak ALT, instead, it peaked prior to ALT by around 2 weeks [Yeo et al. 2001]. In HBsAg-negative/anti-HBc-positive subjects, serum HBV DNA preceded elevated ALT by 12–28 weeks [Hui et al. 2006]. HBsAg seroreversion developed after rise in serum HBV DNA and before ALT elevation [Hui et al. 2006]. HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; ALT, alanine transaminase.