Prospective evaluation of seropositive occult hepatitis B viral infection in lymphoma patients receiving chemotherapy.

Abstract

OBJECTIVE. To serially evaluate the viral kinetics of occult hepatitis B virus infection in lymphoma patients and perform a correlation with clinical outcomes. DESIGN. Case series with 1-year follow-up. SETTING. Regional hospital, Hong Kong. PATIENTS. Consecutive patients who were newly diagnosed to have lymphoma in the hospital between 1 April 2007 and 31 March 2008 were tested for hepatitis B (HB) surface (s) antigen (Ag), anti-HBs antibody (Ab) and anti-HB core (c) Ab. Seropositive occult hepatitis B patients as defined by being negative for HBsAg but positive anti-HBsAb and/or anti-HBcAb without a hepatitis B vaccination history were recruited. Serum HBsAg, anti-HBsAb, anti-HBcAb, hepatitis B virus deoxyribonucleic acid (DNA) level, and liver biochemistry were checked at baseline and every 4 weeks during and after chemotherapy until 12 months after the completion of chemotherapy or death. Entecavir was started if patients developed biochemical flare-up of hepatitis B associated with virological rebound. The prevalence and course of hepatitis B virus-related hepatitis, as well as any temporal relationship to viral kinetics and clinical hepatitis, were assessed. RESULTS. Of 47 patients tested, 10 (21%) with lymphoma were seropositive occult hepatitis carriers. Their median baseline hepatitis B virus DNA level was 89 IU/mL (range, <34-807 IU/mL). Virological rebound (as defined by a 10-fold increase in serum hepatitis B virus DNA level from pre-chemotherapy level persisted for 4 weeks) occurred in one of the 10 patients, followed by biochemical reactivation. Whereupon entecavir treatment was started and no liver failure ensued. Regarding the other seropositive occult patients, their serum hepatitis B virus DNA levels fluctuated, but there was no associated biochemical reactivation. CONCLUSION. Detectable baseline serum hepatitis B virus DNA is not uncommon in patients with occult hepatitis B who receive chemotherapy. Transient elevation in serum hepatitis B virus DNA levels does not predict biochemical reactivation, but antiviral treatment might be considered if virological rebound persists.

• Authors: W I Cheung, S Y Lin, Vincent K S Leung, Kitty S C Fung, Y K Lam, F H Lo, T N Chau
• Journal: Hong Kong medical journal = Xianggang yi xue za zhi (Hong Kong Med J) Vol. 17 Issue 5 Pg. 376-80 (Oct 2011) ISSN: 1024-2708 [Print] China
• PMID: 21979474 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents
• DNA, Viral
• Hepatitis B Antibodies
• Hepatitis B Core Antigens
• Hepatitis B Surface Antigens
• Epirubicin
• Rituximab
• entecavir
• Vincristine
• Guanine
• Cyclophosphamide
• Prednisolone

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Antiviral Agents (therapeutic use)
• Carrier State (immunology)
• Cyclophosphamide (administration & dosage)
• DNA, Viral (blood)
• Epirubicin (administration & dosage)
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B (complications, drug therapy, immunology)
• Hepatitis B Antibodies (blood)
• Hepatitis B Core Antigens (blood)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B virus (immunology)
• Humans
• Liver Function Tests
• Lymphoma (complications, drug therapy, immunology)
• Male
• Middle Aged
• Prednisolone (administration & dosage)
• Prospective Studies
• Rituximab
• Time Factors
• Vincristine (administration & dosage)
• Viral Load