Reactivation of hepatitis B virus infection after cytotoxic chemotherapy or immunosuppressive therapy

  • Manzano-Alonso M
  • Castellano-Tortajada G
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Abstract

Reactivation of hepatitis B is defined as the recurrence or an abrupt rise in hepatitis B virus (HBV) replication, often accompanied by an increase in serum transaminase levels, and both events occurring in a patient with a previous inactive hepatitis B infection. This reactivation can occur in situations in which the ratio of HBV replication and immune response is altered. It can happen during the treatment of hemato-oncological malignancies with chemotherapy and in immunosuppression of autoimmune diseases. Clinical manifestations of hepatitis B reactivation are variable and can range from asymptomatic to acute hepatitis, which are sometimes serious and result in acute liver failure with risk of death, and usually occur in the periods between cycles or at the end of chemotherapy. Immunosuppressive drugs such as corticosteroids or azathioprine can induce HBV reactivation in patients carrying hepatitis B virus surface antigen (HBsAg) or anti-HBc, but much less frequently than chemotherapy treatments. The tumor necrosis factor alpha inhibitors infliximab, etanercept and adalimumab may cause reactivation of hepatitis B, and the over all frequency with infliximab may be similar (50%-66%) to that caused by chemotherapy. Baseline HBV serology is recommended for all patients receiving chemotherapy and immunosuppressive drugs, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates. © 2011 Baishideng. All rights reserved.

Author-supplied keywords

  • Crohn disease/dt [Drug Therapy]
  • Hepatitis B virus
  • Hepatitis b
  • Immune response
  • Immunosuppression
  • Reactivation
  • acute hepatitis
  • acute liver failure
  • adalimumab
  • adalimumab/ae [Adverse Drug Reaction]
  • adalimumab/cm [Drug Comparison]
  • adalimumab/dt [Drug Therapy]
  • alkylating agent/ae [Adverse Drug Reaction]
  • aminotransferase blood level
  • ankylosing spondylitis/dt [Drug Therapy]
  • antineoplastic agent/ae [Adverse Drug Reaction]
  • antineoplastic alkaloid/ae [Adverse Drug Reaction]
  • antineoplastic antibiotic/ae [Adverse Drug Reactio
  • antineoplastic antimetabolite/ae [Adverse Drug Rea
  • antivirus agent/dt [Drug Therapy]
  • article
  • autoimmune disease
  • azathioprine
  • azathioprine/ae [Adverse Drug Reaction]
  • bleomycin/ae [Adverse Drug Reaction]
  • bone marrow transplantation
  • breast cancer
  • cancer chemotherapy
  • chemotherapy
  • chlorambucil/ae [Adverse Drug Reaction]
  • cisplatin/ae [Adverse Drug Reaction]
  • corticosteroid therapy
  • corticosteroid/ae [Adverse Drug Reaction]
  • cyclophosphamide/ae [Adverse Drug Reaction]
  • cytarabine/ae [Adverse Drug Reaction]
  • cytotoxic agent/ae [Adverse Drug Reaction]
  • dactinomycin/ae [Adverse Drug Reaction]
  • daunorubicin/ae [Adverse Drug Reaction]
  • death
  • doxorubicin/ae [Adverse Drug Reaction]
  • drug withdrawal
  • epirubicin/ae [Adverse Drug Reaction]
  • etanercept
  • etanercept/ae [Adverse Drug Reaction]
  • etanercept/cm [Drug Comparison]
  • etanercept/dt [Drug Therapy]
  • fluorouracil/ae [Adverse Drug Reaction]
  • hematologic disease
  • hematologic malignancy
  • hepatitis B core antibody
  • hepatitis B surface antigen
  • hepatitis B/co [Complication]
  • hepatitis B/di [Diagnosis]
  • hepatitis B/dr [Drug Resistance]
  • hepatitis B/dt [Drug Therapy]
  • hepatitis B/et [Etiology]
  • hepatitis B/pc [Prevention]
  • hepatitis B/si [Side Effect]
  • human
  • immunosuppressive agent
  • immunosuppressive agent/ae [Adverse Drug Reaction]
  • immunosuppressive agent/dt [Drug Therapy]
  • immunosuppressive agent/pd [Pharmacology]
  • immunosuppressive treatment
  • infection
  • infection risk
  • infliximab
  • infliximab/ae [Adverse Drug Reaction]
  • infliximab/cm [Drug Comparison]
  • infliximab/dt [Drug Therapy]
  • juvenile rheumatoid arthritis/dt [Drug Therapy]
  • lamivudine/dt [Drug Therapy]
  • liver cell carcinoma
  • lung cancer
  • mitomycin C/ae [Adverse Drug Reaction]
  • monoclonal antibody/ae [Adverse Drug Reaction]
  • mortality
  • nasopharynx carcinoma
  • nonhuman
  • patient
  • prophylaxis
  • psoriasis/dt [Drug Therapy]
  • rheumatic disease/dt [Drug Therapy]
  • rheumatoid arthritis/dt [Drug Therapy]
  • risk
  • serology
  • treatment outcome
  • tumor necrosis factor alpha inhibitor
  • tumor necrosis factor alpha inhibitor/ae [Adverse
  • tumor necrosis factor alpha inhibitor/pd [Pharmaco
  • unindexed drug
  • vinblastine/ae [Adverse Drug Reaction]
  • vincristine/ae [Adverse Drug Reaction]
  • virus hepatitis/co [Complication]
  • virus hepatitis/di [Diagnosis]
  • virus hepatitis/dr [Drug Resistance]
  • virus hepatitis/et [Etiology]
  • virus hepatitis/pc [Prevention]
  • virus infection
  • virus reactivation
  • virus replication

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Authors

  • M L Manzano-Alonso

  • G Castellano-Tortajada

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