Hepatitis B virus reactivation in patients receiving cancer chemotherapy: natural history, pathogenesis, and management

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http://www.springerlink.com/content/e486310264726454/

Hepatology International

DOI: 10.1007/s12072-011-9279-6Online First™

Review Article

Hepatitis B virus reactivation in patients receiving cancer chemotherapy:

natural history, pathogenesis, and management

Chun-Jen Liu, Pei-Jer Chen, Ding-Shinn Chen and Jia-Horng Kao

Abstract

Chronic hepatitis B virus (HBV) infection is endemic in the Asian-Pacific

region, and reactivation of HBV post-cancer chemotherapy has become an emerging

clinical challenge. Patients with detectable serum HBV DNA before chemotherapy

and those receiving intensive chemotherapy are particularly at a risk of HBV

reactivation. Most patients with HBV reactivation are positive for hepatitis B

surface antigen (HBsAg) and are, therefore, easily identified by recommended

serological screening before chemotherapy. However, a small, but significant

proportion of subjects who have apparently recovered from HBV infection as

reflected by HBsAg negativity and hepatitis B core antibody positivity in HBV

endemic areas may also experience reactivation when host immunity is severely

compromised by cancer chemotherapy. Serum alanine aminotransferase, HBsAg,

and/or HBV DNA should be monitored closely in these subjects and antiviral

therapy should be administered immediately when any evidence of HBV reactivation

is detected during chemotherapy. The prophylactic use of nucleos(t)ide analogs

before chemotherapy and its continuation until reconstitution of host immunity

remain the mainstay of effective prevention of hepatitis B reactivation in this

special clinical entity.