Abstract
Background: Occult hepatitis B infection is defined by negative hepatitis B surface antigen (HBsAg) and detectable hepatitis B virus (HBV DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation is most commonly reported in patients receiving cancer chemotherapy for haematological malignancies or hematopoietic stem cell transplantation (HSCT) recipients.
Objective: In this study, we aimed to determine the prevalence & reactivation of occult HBV infection in hematological cancer patients on & before receiving chemotherapy.
Methods: The study was conducted in patients admitted in hematology department RGGGH, Madras medical college, Chennai for a time period from September 2018 to December 2018.Blood samples collected from newly diagnosed hematological malignancy and patients with diagnosed hematological malignancy on chemotherapy who were previously negative for HBsAg, were tested for HBsAg & anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR).
Results: Out of the 80 patients tested, 23 (28%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 5(6%) of anti-HBc positive samples. Reactivation of HBV occurred in 11% of patients. Reactivation was more frequent with chemotherapy drugs like Rituximab & daunorubicin. There was no significant difference in HBc antibody positivity based on gender, age, previous blood transfusions, biochemical parameters (ALT) (P>0.05).
Conclusion: The prevalence of occult HBV infection is 6% with isolated anti HBC positivity being 28%.Reactivation of HBV was seen in 9 patients (11%) Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be made mandatory before starting patients on immunosuppressants in cancer patients.
References
- Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, arid current and emerging prevention and control measures. Journal of Viral Hepatitis. 2004;11:97–107.
- Liu Y, Li P, Li C, Zhou J, Wu C, Zhou YH. Detection of hepatitis B virus DNA among accepted blood donors in Nanjing, China. Virol J 2010; 7: 193.
- Liu CJ, Kao JH. Global perspective on the natural history of chronic hepatitis B: role of hepatitis B virus genotypes a to j. Semin Liver Dis 2013; 33: 97–102.
- Raimondo G, Navarra G, Mondello S, Costantino L, Colloredo G, Cucinotta E. Occult hepatitis B virus in liver tissue of individuals without hepatic disease. J Hepatol. 2008;48:743–6.
- Perrillo RP. Acute ares in chronic hepatitis B: The natural and unnatural history of an immunologically mediated liver disease. Gastroenterology 2001;120:1009‐22.
- Cheng JC, Liu MC, Tsai SY, Fang WT, Jer‐Min Jian J, Sung JL. Unexpectedly frequent hepatitis B reactivation by chemoradiation in post gastrectomy patients. Cancer 2004;101:2126‐33.
- Lau GK, Leung YH, Fong DY, Au WY, Kwong YL, Lie A, et al. High hepatitis B virus (HBV) DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic transplantation. Blood 2002; 99:2324‐30.
- Torbenson M, Thomas D. Occult hepatitis B. Lancet Infect Dis. 2002;2:479–86.
- Candotti D, Allain JP. Transfusion-transmitted hepatitis B virus infection.
J Hepatol. 2009;51:798–809.
- Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with haematological malignancies. Br J Hae-matol. 2007;136:699-712.
- Yeo W, Chan PK, Hui P, Ho WM, Lam KC, Kwan WH, Zhong S, Johnson PJ. Hepatitis B virus reactivation in breast cancer patients receiving cytotoxic chemotherapy: a prospective study. J Med Virol. 2003;70:553-61.
- Yeo W, Chan PKS, Ho WM, Zee B, Lam KC, Lei KI, et al. Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemo-therapy. J ClinOncol 2004;22:927–34.
- Lok AS, McMahon BJ. Chronic hepatitis B: update. Hepatology. 2009;50:661-2.
- Yeo W, Johnson PJ. Diagnosis prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology. 2006;43:209–20.
- DeMitri, MS, Cassini R, Bernardi M. Hepatitis B virus-related hepatocarcino- genesis: molecular oncogenic potential of clear or occult infections. Eur J Cancer. 2010;46:2178-86.
- Silva C, Goncales NS, Pereira JS, Escanhoela CA, Pavan MH, Goncales Jr FL. The in uence of occult infection with hepatitis B virus on liver histology and response to interferon treatment in chronic hepatitis C patients. Braz J Infect Dis. 2004;8:431–9.
- Sodhi JS, Jeelani S, Geelani S. Occult hepatitis B virus infection as a cause of post transfusion hepatitis in patients with cancers. Indian J Gastroenterol. 2013;32: 297-301.
- Yeo W, Chan TC, Leung NW, Lam WY, Mo FK, Chu MT, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J ClinOncol 2009;27:605–11.
- Francisci D, Falcinelli F, Schiaroli E, Capponi M, Belfiori B, Cecchini E, et al. Reactivation of hepatitis B virus replication due to cytotoxic therapy: a five-year prospective study. Tumori 2012;98:220–4.
- Elkady A, Aboulfotuh S, Ali EM, Sayed D, Abdel-Aziz NM, Ali AM, et al. Incidence and characteristics of HBV reactivation in hematological malignant patients in south Egypt. World J Gastroenterol 2013;19(37):6214–20.
- Eren OO, Artac M, Boruban MC, Yavas O, Arslan U, Basaranoglu M. Chemotherapy‐induced Hepatitis B virus reactivation in HbsAg positive cancer patient: A single center experience. Med Oncol 2009;26:386‐92.
- Paul S, Saxena A, Terrin N et al. Hepatitis B virus reactivation and prophylaxis during solid tumor chemotherapy: a systematic review and meta-analysis. Ann Intern Med 2016; 164: 30–40.
- Fong TL, Di Bisceglie AM, Gerber MA, Waggoner JG, Hoofnagle JH. Persistence of hepatitis B virus DNA in the liver after loss of HBsAg in chronic hepatitis B. Hepatology. 1993;18:1313–8.
- Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral
hepatitis B reactivation in patients with haematological malignancies. Br J Haematol. 2007;136:699-712.
- Onozawa M, Hashino S, Izumiyama K. Progressive disappearance of anti-hep- atitis B surface antigen antibody and reverse seroconversion after allogeneic hematopoietic stem cell transplantation in patients with previous hepatitis B virus infection. Transplantation. 2005;79:616–19.
Corresponding Author
A R Venkateshwaran
Director and Head of Department, Institute of Medical Gastroenterology, Madras Medical College Chennai
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.114
