Reactivation of Hepatitis B With Reappearance of Hepatitis B Surface Antigen After Chemotherapy and Immunosuppression
published online 03 July 2009.
Background & Aims
HBV infection may reactivate in the setting of immunosuppression, although the frequency and consequences of HBV reactivation are not well known. We report 6 patients who experienced loss of serologic markers of hepatitis B immunity and reappearance of HBsAg in the serum as a result of a variety of acquired immune deficiencies.
Methods
Between 2000 and 2005, six patients with reactivation of hepatitis B were seen in consultation by the Liver Diseases Branch at the Clinical Center, National Institutes of Health. The course and outcome of these 6 patients were reviewed.
Results
All 6 patients developed reappearance of HBsAg and evidence of active liver disease after stem cell transplantation (n = 4), immunosuppressive therapy (n = 1), or change in human immunodeficiency virus antiretroviral regimen (n = 1), despite having antibody to HBsAg (anti-HBs) or antibody to hepatitis B core antigen (anti-HBc) without HBsAg before. All 6 patients developed chronic hepatitis B, 2 patients transmitted hepatitis B to their spouses, and 1 patient developed cirrhosis. The diagnosis of hepatitis B reactivation was frequently missed or delayed and often required interruption of the therapy for the underlying condition. None of the patients received antiviral prophylaxis against HBV reactivation.
Conclusions
Serologic evidence of recovery from hepatitis B infection does not preclude its reactivation after immunosuppression. Screening for serologic evidence of hepatitis B and prophylaxis of those with positive results by using nucleoside analogue antiviral therapy should be provided to individuals in whom immunosuppressive therapy is planned.
§§National Cancer Institute, National Institutes of Health, Bethesda, Maryland
∥∥National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
¶¶National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Reprint requests Address requests for reprints to: Tara N. Palmore, MD, National Institute of Allergy and Infectious Diseases, NIH, 10 Center Drive, MSC 1888, Bethesda, Maryland 20892-1888. fax: (301) 496-7383
Conflicts of interest The authors disclose the following: Dr Uri Lopatin runs the HBV translational medicine program at Roche Pharmaceuticals. He made his contributions to the manuscript 3 years ago, when he was an NIH fellow. The remaining authors disclose no conflicts.
Funding This research was supported by the Intramural Research Programs of the NIDDK (Z01 DK054514-02), NIAID, NHLBI, and NCI, NIH.
ABSTRACT