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Hepatitis B Reactivation in the Setting of Chemotherapy and Immunosuppression

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Chronic Viral Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Key Principles

•Reactivation of hepatitis B is recognized as the reappearance of active necroinflammatory disease of the liver in a person known to have the inactive hepatitis B surface antigen (HBsAg) carrier state or resolved hepatitis B.

•More recently, hepatitis B reactivation has been defined as a one log or greater increase in the HBV DNA level compared with the prereactivation level, or the reappearance of a previously negative HBsAg on two consecutive tests.

•Reactivation may result in acute flares of HBV, with consequent clinical decompensation.

•Patients at risk for hepatitis B reactivation are those with hematological or oncological malignancies who require chemotherapy, patients with non-malignant diseases who require immunosuppression, and patients with rheumatologic diseases or inflammatory bowel diseases treated with biologic response modifiers.

•With the administration of cytotoxic or immunosuppressive agents, the immune response is suppressed, viral replication is enhanced, and widespread infection of hepatocytes ensues. With the discontinuation of the cytotoxic or immunosuppressive therapy, the immune function is restored. This immune reconstitution results in a rapid destruction of hepatocytes infected with hepatitis B.

•Patients who are negative for HBsAg but have evidence of either circulating or intrahepatic hepatitis B viral (HBV) DNA are denoted as having occult HBV. It is well established that chemotherapy can cause HBV reactivation even in HBsAg-negative patients with occult HBV infection.

•All patients should undergo screening for occult or overt HBV prior to the initiation of chemotherapy or immunomodulatory therapy. Seronegative patients should be vaccinated against HBV.

•HBsAg-positive patients should be considered at high risk of reactivation and should be started on preemptive anti-HBV therapy.

•If reactivation of HBV occurs, prompt antiviral therapy should be combined with aggressive supportive therapy in addition to the cessation of chemotherapy.

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  1. Georgetown University Medical Center, Washington, DC, USA

    Halim Charbel MD & James H. Lewis MD, FACP, FACG

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  2. James H. Lewis MD, FACP, FACG
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  1. Department of Hepatology, Georgetown University Hospital, Reservoir Road GUH 3800, Washington, 20007, U.S.A.

    Kirti Shetty

  2. University of Connecticut Health Center, Farmington Ave. 236, Farmington, 06030-1845, U.S.A.

    George Y. Wu

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Charbel, H., Lewis, J.H. (2009). Hepatitis B Reactivation in the Setting of Chemotherapy and Immunosuppression. In: Shetty, K., Wu, G. (eds) Chronic Viral Hepatitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-565-7_12

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