Clinical and Molecular Hepatology

"Virus activation"

Original Article

Viral hepatitis

Hepatitis B screening rates and reactivation in solid organ malignancy patients undergoing chemotherapy in Southern Thailand: Ratchapong Laiwatthanapaisan, Pimsiri Sripongpun, Naichaya Chamroonkul, Arunee Dechaphunkul, Chirawadee Sathitruangsak, Siwat Sakdejayont, Chanon Kongkamol, Teerha Piratvisuth; Clin Mol Hepatol 2019;25(4):366-373.
Published online July 17, 2019; DOI: https://doi.org/10.3350/cmh.2018.0111

Abstract
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Background/Aims
Hepatitis B virus reactivation (HBVr) following chemotherapy (CMT) is well-known among hematologic malignancies, and screening recommendations are established. However, HBVr data in solid organ malignancy (SOM) patients are limited. This study aims to determine hepatitis B surface antigen (HBsAg) screening rates, HBV prevalence, and the rate of significant hepatitis caused by HBVr in SOM patients undergoing CMT.
Methods
Based on the Oncology unit’s registration database from 2009–2013, we retrospectively reviewed records of all SOM patients ≥18 years undergoing CMT at Songklanagarind Hospital who were followed until death or ≥6 months after CMT sessions. Exclusion criteria included patients without baseline liver function tests (LFTs) and who underwent CMT before the study period. We obtained and analyzed baseline clinical characteristics, HBsAg screening, and LFT data during follow-up.
Results
Of 3,231 cases in the database, 810 were eligible. The overall HBsAg screening rate in the 5-year period was 27.7%. Screening rates were low from 2009–2012 (7.8–21%) and increased in 2013 to 82.9%. The prevalence of HBV among screened patients was 7.1%. Of those, 75% underwent prophylactic antiviral therapy. During the 6-month follow-up period, there were three cases of significant hepatitis caused by HBVr (4.2% of all significant hepatitis cases); all were in the unscreened group.
Conclusions
The prevalence of HBV in SOM patients undergoing CMT in our study was similar to the estimated prevalence in general Thai population, but the screening rate was quite low. Cases of HBVr causing significant hepatitis occurred in the unscreened group; therefore, HBV screening and treatment in SOM patients should be considered in HBV-endemic areas.

Citations

Citations to this article as recorded by

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Case Report

Viral hepatitis

A fatal case of hepatitis B virus (HBV) reactivation during long-term, very-low-dose steroid treatment in an inactive HBV carrier: Joong Ho Bae, Joo Hyun Sohn, Hye Soon Lee, Hye Sun Park, Yil Sik Hyun, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Dong Soo Han; Korean J Hepatol 2012;18(2):225-228.
Published online June 26, 2012; DOI: https://doi.org/10.3350/cmh.2012.18.2.225

Abstract
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Hepatitis B virus (HBV) may be reactivated after chemotherapy or immunosuppressive therapy, and therefore administration of antiviral agents before such treatment is recommended. Most reported cases of reactivation are associated with high doses of immunosuppressive agents or combination therapy. We present a case of a previously inactive HBV carrier with an acute severe flare-up during a long-term, very-low-dose (2.5 mg/day) steroid treatment for rheumatoid arthritis. We suggest that even a minimal dose of single-regimen oral steroid can cause reactivation of indolent, inactive HBV.

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