— Christine M. Kukka, Project Manager, HBV Advocate
Even when a hepatitis B infection is “inactive” or a patient has cleared the hepatitis B surface antigen (HBsAg), patients risk a dangerous reactivation of infection when they are treated with chemotherapy for lymphoma, breast or other cancers, according to a new study on chemotherapy-related reactivations.
Researchers argue that all hepatitis B patients must be monitored and treated with new, potent antivirals to prevent a deadly reactivation.
Researchers, reporting in the October issue of the World Journal of Gastroenterology, reviewed recent studies to find out who exactly was at risk of hepatitis B reactivation.
Is someone who has normal ALTs and undetectable viral load at risk? Or is someone who has cleared the infection and has low levels of surface antibodies at risk?
They experts assert that anyone who has ever been infected is at risk of reactivation when treated with immune-suppressing chemotherapy, especially the drug rituximab, used to treat non-Hodgkin’s lymphoma.
People with prior HBV infections treated with chemotherapy have:
- A 24% risk of reactivation if they are treated with rituximab
- A 14%-21% rate if they are treated for solid tumors
- And a 41%-56% rate if they are treated for breast cancer.
Reactivation can occur even if patients have cleared HBsAg and have surface antibodies. Those at higher risk of HBV reactivation during chemotherapy treatment include males and young patients, and of course those who have "active" hepatitis B with elevated liver enzymes, which indicate ongoing liver damage.
Researchers noted that new antivirals, including entecavir, are far more effective at preventing reactivation than lamivudine (Epivir-HBV).
The most successful preventive treatment, researchers noted, uses entecavir before chemotherapy begins and continues for several months after chemotherapy ends.
Labels: chemotherapy, HBV Reactivation, non-Hodgkin's lymphoma, rituximab
