Comprehensive outcomes of on- and off-antiviral prophylaxis in hepatitis B patients undergoing cancer chemotherapy: A competing risks analysis.

Abstract

Although antiviral prophylaxis is essential in hepatitis B patients in the context of cancer chemotherapy, there is little evidence-based consensus regarding the appropriate prevention strategy depending on the underlying type of cancer and viral status. This retrospective study included a comprehensive cohort of 302 hepatitis B surface antigen-positive patients with various cancers undergoing chemotherapy and antiviral prophylaxis. The rates of hepatitis B virus (HBV) reactivation during antiviral therapy (>1 log10 IU/mL increase or positive conversion of serum HBV DNA) and relapse when off antivirals ([re]appearance of HBV DNA >2,000 IU/ml with related alanine aminotransferase elevation) were evaluated, together with the associated risk factors, in a competing risks analysis where cancer death was considered as the competing event. During antiviral prophylaxis, HBV was reactivated in six patients (1.9%), who had leukemia (n = 4) or lymphoma (n = 2) and were treated with lamivudine (n = 4) or entecavir (n = 2). The incidence rate of HBV relapse in 127 off-prophylaxis patients was 21.3% during a median post-antiviral period of 11.7 months. Lymphoma, pre-prophylactic HBV DNA ≥2,000 IU/ml, and age ≥50 years were independent predictors of off-treatment HBV relapse (adjusted hazard ratios 5.25, 3.07, and 0.34, respectively; Ps < 0.05). Antiviral and anticancer drugs, duration of consolidation on antiviral prophylaxis, and HBeAg positivity were not independent predictors. In conclusion, hepatitis B flare-ups are not rare in patients receiving cancer chemotherapy during and after anti-HBV prophylaxis, even when potent antivirals are used. Patients with hematopoietic or lymphoid neoplasms or high viral burdens should receive prolonged and powerful HBV prophylaxis. J. Med. Virol. 88:1576-1586, 2016. © 2016 Wiley Periodicals, Inc.

• Authors: Jihyun An, Ju Hyun Shim, Seon-Ok Kim, Jonggi Choi, Sang-We Kim, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh
• Journal: Journal of medical virology (J Med Virol) Vol. 88 Issue 9 Pg. 1576-86 (09 2016) ISSN: 1096-9071 [Electronic] United States
• PMID: 26945543 (Publication Type: Journal Article)
• Copyright: © 2016 Wiley Periodicals, Inc.

Chemical References

• Antineoplastic Agents
• Antiviral Agents
• DNA, Viral
• Hepatitis B Antibodies
• Hepatitis B Surface Antigens
• Lamivudine
• entecavir
• Guanine
• Alanine Transaminase

Topics

• Adult
• Alanine Transaminase (blood)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Antiviral Agents (administration & dosage, adverse effects, therapeutic use)
• DNA, Viral (blood)
• Female
• Guanine (administration & dosage, analogs & derivatives)
• Hepatitis B Antibodies (blood)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B virus (drug effects, immunology)
• Hepatitis B, Chronic (virology)
• Humans
• Lamivudine (therapeutic use)
• Lymphoma (drug therapy)
• Male
• Middle Aged
• Neoplasms (complications, drug therapy, mortality)
• Retrospective Studies
• Risk Assessment
• Viral Load
• Virus Activation (drug effects)