Supportive Care in Cancer

, Volume 20, Issue 11, pp 2999–3008

Hepatitis B virus management to prevent reactivation after chemotherapy: a review

  • Jessica P. Hwang
  • John M. Vierling
  • Andrew D. Zelenetz
  • Susan C. Lackey
  • Rohit Loomba
Review Article

DOI: 10.1007/s00520-012-1576-7

Cite this article as:
Hwang, J.P., Vierling, J.M., Zelenetz, A.D. et al. Support Care Cancer (2012) 20: 2999. doi:10.1007/s00520-012-1576-7

Abstract

Purpose

Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy.

Methods

We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library.

Results

Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests—HBsAg, anti-HBc, and anti-HBs—allows the most thorough interpretation of a patient’s serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies.

Conclusions

Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.

Keywords

Hepatitis B virus Reactivation Chemotherapy Cancer Review 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jessica P. Hwang
    • 1
    • 5
  • John M. Vierling
    • 2
  • Andrew D. Zelenetz
    • 3
  • Susan C. Lackey
    • 1
  • Rohit Loomba
    • 4
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.Memorial Sloan-Kettering Cancer CenterNew York CityUSA
  4. 4.The University of California San DiegoLa JollaUSA
  5. 5.Department of General Internal MedicineHoustonUSA

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