| Theme | Cutting Edge : Pathogenesis and Treatment of Hepatitis B | |
|---|---|---|
| Title | Prevention of Chemotherapy-induced Viral Hepatitis B Reactivation | |
| Publish Date | 2009/06 | |
| Author | Makoto Oketani | Department of Digestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences |
| Author | Hirofumi Uto | Department of Digestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences |
| Author | Akio Ido | Department of Digestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences |
| Author | Hirohito Tsubouchi | Department of Digestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences |
| [ Summary ] | Reactivation of the hepatitis B virus (HBV) is common following chemotherapy and is associated with high mortality rates despite prompt anti-vairal treatment. Consequently, prophylactic anti-viral treatment is recommended for HBsAg-positive patiens before chemotherapy or immunosuppressive treatment. Recently, HBV reactivation related to newer therapeutic regimens, such as rituximab (anti-CD20)-plus-CHOP has been increasingly reported. HBV reactivation also occurs in patients in posthepatitis B status (negative for HBsAg and positive for HBcAb and/or HBsAb). This condition is associated with a higher risk of fulminant failure with a mortality rate of 100%. We proposed guidelines for screening and preemptive anti-viral treatment for patients at risk. Pre-treatment anti-HBc and anti-HBs testing should be performed in HBsAg-negative patients, especially those receiving rituximab plus steroid-containig regimens. Furthermore, anti-HBc positive and/or anti-HBs positive patients should be monitored for detectable increases in serum HBV DNA during and after completion of chemotherapy. This will facilitate prophylactic commencement of nucleoside analogs. | |