Clinical Gastroenterology and Hepatology
Volume 7, Issue 10 , Pages 1130-1137, October 2009

Reactivation of Hepatitis B With Reappearance of Hepatitis B Surface Antigen After Chemotherapy and Immunosuppression

  • Tara N. Palmore

      Affiliations

    • National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
    • Corresponding Author InformationReprint 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
    • ,
  • Neeral L. Shah

      Affiliations

    • University of Virginia Health System, Charlottesville, Virginia
    • ,
  • Rohit Loomba

      Affiliations

    • University of California at San Diego, San Diego, California
    • ,
  • Brian B. Borg

      Affiliations

    • Washington University, St Louis, Missouri
    • ,
  • Uri Lopatin

      Affiliations

    • Roche Pharmaceuticals, Nutley, New Jersey
    • ,
  • Jordan J. Feld

      Affiliations

    • University of Toronto, Toronto, Ontario, Canada
    • ,
  • Farooq Khokhar

      Affiliations

    • Chambersburg Gastroenterology Associates, LTD, Chambersburg, Pennsylvania
    • ,
  • Glen Lutchman

      Affiliations

    • Stanford University, Palo Alto, California
    • ,
  • David E. Kleiner

      Affiliations

    • National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • Neal S. Young

      Affiliations

    • National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • Richard Childs

      Affiliations

    • National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • A. John Barrett

      Affiliations

    • National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
    • ,
  • T. Jake Liang

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
    • ,
  • Jay H. Hoofnagle

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
    • ,
  • Theo Heller

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland

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.

Abbreviations used in this paper: ALP, alkaline phosphatase, anti-HBc, antibody to hepatitis B core antigen, anti-HBs, antibody to hepatitis B surface antigen, CML, chronic myelogenous leukemia, GVHD, graft-versus-host disease, HIV, human immunodeficiency virus

 

 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.

PII: S1542-3565(09)00600-4

doi:10.1016/j.cgh.2009.06.027

Clinical Gastroenterology and Hepatology
Volume 7, Issue 10 , Pages 1130-1137, October 2009