Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Jan 5;164(1):30-40.
doi: 10.7326/M15-1121. Epub 2015 Nov 24.

Hepatitis B Virus Reactivation and Prophylaxis During Solid Tumor Chemotherapy: A Systematic Review and Meta-analysis

Sonali Paul, Akriti Saxena, Norma Terrin, Kathleen Viveiros, Ethan M Balk, John B Wong
Meta-Analysis

Hepatitis B Virus Reactivation and Prophylaxis During Solid Tumor Chemotherapy: A Systematic Review and Meta-analysis

Sonali Paul et al. Ann Intern Med. .

Abstract

Background: Solid tumor chemotherapy regimens pose a risk for hepatitis B virus (HBV) reactivation, but screening and antiviral prophylaxis remains controversial because of insufficient evidence.

Purpose: To determine the risk for HBV reactivation with and without antiviral prophylaxis and the effectiveness of prophylaxis in adults with solid tumors and chronic or resolved HBV infection.

Data sources: MEDLINE through 1 July 2015 and Web of Science, Cochrane Central Register of Controlled Trials, TOXNET, and Scopus through 1 March 2015.

Study selection: 26 English-language observational studies and randomized, controlled trials in patients with chronic or resolved HBV receiving chemotherapy for solid tumors.

Data extraction: Study characteristics, quality, and risk of bias were assessed by 1 researcher and verified by another independent researcher.

Data synthesis: Random-effects model meta-analyses were used to estimate the risk and odds ratio (OR) of reactivation with versus without antiviral prophylaxis. Reactivation in chronic HBV without prophylaxis ranged from 4% to 68% (median, 25%) with substantial heterogeneity. Prophylaxis reduced the risk for HBV reactivation (OR, 0.12 [95% CI, 0.06 to 0.22]), HBV-related hepatitis (OR, 0.18 [CI, 0.10 to 0.32]), and chemotherapy interruption (OR, 0.10 [CI, 0.04 to 0.27]). In 3 studies of patients with resolved HBV infection, none received HBV prophylaxis and reactivation risk ranged from 0.3% to 9.0%.

Limitations: Significant heterogeneity in underlying study populations and treatment regimens, incomplete baseline data, possibility of publication bias, and limited study quality. Most studies were observational and from Asia.

Conclusion: In patients with chronic HBV receiving solid tumor chemotherapy, the risk for HBV reactivation is similar to the risk with other types of immunosuppressive therapy. Results support HBV screening and antiviral prophylaxis before initiation of chemotherapy for solid tumors.

Primary funding source: National Center for Advancing Translational Sciences and National Institutes of Health.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Dr. Paul reports grants from National Center for Advancing Translational Sciences, National Institutes of Health, and the 2013 to 2014 Bristol-Myers Squibb Virology Research Training Program during the conduct of the study. Dr. Wong reports nonfinancial support from the American Association for the Study of Liver Diseases (as a member of systematic review writing group for an HBV practice guideline) outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewedatwww.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15–1121.

Figures

Appendix Figure 1.
Appendix Figure 1.
Summary of evidence search and selection.
Appendix Figure 2.
Appendix Figure 2.
Absolute risk for HBV reactivation without antiviral prophylaxis in patients with chronic HBV, by chemotherapy subtype.
Appendix Figure 3.
Appendix Figure 3.
Absolute risk for secondary outcomes without antiviral prophylaxis in patients with solid tumors and chronic HBV infection.
Appendix Figure 4.
Appendix Figure 4.
Absolute risk for HBV reactivation without antiviral prophylaxis in patients with resolved HBV infection.
Figure 1.
Figure 1.
Absolute risk for HBV reactivation without antiviral prophylaxis in patients with chronic HBV infection.
Figure 2.
Figure 2.
Absolute risk for HBV reactivation without antiviral prophylaxis in patients with chronic HBV infection, by tumor subtype.
Figure 3.
Figure 3.
Odds ratio for HBV reactivation with and without antiviral prophylaxis in patients with chronic HBV infection.
Figure 4.
Figure 4.
Odds ratio for secondary outcomes with and without antiviral prophylaxis in patients with chronic HBV infection.
See this image and copyright information in PMC

References

    1. Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. J Hepatol. 2003;39 Suppl 1:S64–9. [PMID: ] - PubMed
    1. Wasley A, Kruszon-Moran D, Kuhnert W, Simard EP, Finelli L, McQuillan G, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202:192–201. [PMID: ] - PubMed
    1. Hwang JP, Vierling JM, Zelenetz AD, Lackey SC, Loomba R. Hepatitis B virus management to prevent reactivation after chemotherapy: a review. Support Care Cancer. 2012;20:2999–3008. [PMID: ] - PMC - PubMed
    1. Lok AS, Ward JW, Perrillo RP, McMahon BJ, Liang TJ. Reactivation of hepatitis B during immunosuppressive therapy: potentially fatal yet preventable. Ann Intern Med. 2012;156:743–5. [PMID: ] - PMC - PubMed
    1. Shouval D, Shibolet O. Immunosuppression and HBV reactivation. Semin Liver Dis. 2013;33:167–77. [PMID: ] - PubMed

Publication types

Substances