Reuters Health Information (2005-11-02): Hepatitis B reactivation possible after chemotherapy
Hepatitis B reactivation possible after chemotherapy
Last Updated: 2005-11-02 13:30:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In hepatitis B (HBV)
infected patients receiving pre-emptive lamivudine treatment before
they undergo cancer chemotherapy, reactivation of the virus is possible
once lamivudine therapy is withdrawn, researchers in Hong Kong report.
They recommend a more prolonged course of antiviral therapy in patients
with a high pre-chemotherapy serum HBV DNA level or who are positive
for HBV e antigen.
Liver damage due to HBV reaction is a two-stage process, Dr. C-K Hui
and associates note in their report, published in the November 5th
issue of Gut. Increased viral replication during cytotoxic therapy is
followed by rapid immune-mediated destruction of HBV-infected
That is why a short course of lamivudine is recommended while
HBV-infected patients undergo cytotoxic or immunosuppressive therapy.
Current recommendations call for lamivudine to be started 1 week before
chemotherapy and continued for at least 6 weeks afterwards, although
the optimal duration has yet to be defined.
To assess the problem of HBV rebound, Dr. Hui and colleagues
prospectively followed 46 HBV-positive patients treated with cytotoxic
chemotherapy for a hematological malignancy at Queen Mary Hospital.
Lamivudine, commenced 1 week prior to starting chemotherapy, was
continued for at least 3 months after discontinuing chemotherapy and
until the total white cell count had normalized.
During follow-up, 11 patients developed HBV reactivation between 6
and 33 months after discontinuing lamivudine. Although lamivudine was
resumed in all 11 cases, three developed fulminant hepatic failure and
Factors predictive of HBV reactivation were HBV DNA levels of 10,000
copies/mL or more, and a positive HBV e antigen test prior to
The authors recommend that all patients undergoing intense cytotoxic
chemotherapy be screened for HBV surface antigen, and those who are
positive be placed on preemptive lamivudine therapy.
Dr. Hui's group notes that the antiviral drug can be withdrawn in
HBV e antigen-negative patients with low pre-chemotherapy serum HBV DNA
levels once white cell counts have returned to normal. They still
advise close monitoring of serum HBV DNA and alanine amino transaminase
levels every 4 weeks for the next 12 months, with lamivudine resumed if
a 10-fold increase in HBV DNA is observed.
However, for patients positive for HBV e antigen or with a high
pre-chemotherapy HBV DNA, lamivudine therapy should be prolonged to
reduce the chance of HBV reactivation.