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Reactivation of Hepatitis B Virus Due to Cancer Chemotherapy and Other Immunosuppressive Drug Therapy

  • Chapter
Hepatitis B Virus in Human Diseases

Part of the book series: Molecular and Translational Medicine ((MOLEMED))

  • 2006 Accesses

Abstract

Hepatitis B virus reactivation (HBVr) is a potentially life-threatening disorder induced by cancer chemotherapy and other forms of immune suppressive drug therapy (ISDT). It occurs in patients with resolved as well as active HBV infection. The clinical spectrum ranges from mild aminotransferase elevations to fulminant liver failure, and it can be associated with a significant risk of morbidity as well as fatalities. HBVr occurs most commonly in patients treated for hematologic malignancies, in particular when B cell depletion therapy is used as part of the regimen. However, it has been frequently reported with anthracycline-based regimens for breast cancer and many other types of malignancy including transarterial chemoembolization for hepatocellular carcinoma. Biologic agents such as tumor necrosis factor (TNF) alpha inhibitors are widely used for rheumatic, dermatologic, and inflammatory disorders of the intestine and they can also cause HBVr. This is of some concern because prescribing providers have incomplete awareness of HBVr during ISDT and its means of prevention. Reactivated hepatitis B is likely to become more common in the future due to the rapid expansion of new biologic approaches to the treatment of malignant and nonmalignant conditions. Much remains to be done in the future to reduce the incidence rates of this potentially fatal yet preventable clinical disorder.

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Abbreviations

6-MP:

6-mercaptopurine

AASLD:

American Association for the Study of Liver Diseases

AGA:

American Gastroenterological Association

ALT:

Alanine aminotransferase

Anti-HBc:

Antibody to hepatitis B core antigen

Anti-HBe:

Antibody to hepatitis B e antigen

Anti-HBs:

Antibody to HBsAg

APASL:

Asian Pacific Association for the Study of the Liver

ASCO:

American Society of Clinical Oncology

AST:

Aspartate aminotransferase level

cccDNA:

Covalently closed circular DNA

CDC:

Centers for Disease Control and Prevention

CHOP:

Cyclophosphamide doxorubicin, vincristine, and prednisone

DMARDs:

Disease-modifying antirheumatic drugs

DNA:

Deoxyribonucleic acid

EASL:

European Association for the Study of the Liver

FDA:

Food and Drug Administration

HBeAg:

Hepatitis B e antigen

HBsAg:

Hepatitis B surface antigen

HBV:

Hepatitis B virus

HBVr:

Hepatitis B virus reactivation

HCC:

Hepatocellular carcinoma

HLA:

Human leukocyte antigen

IL:

Interleukin

INR:

International normalized ratio of prothrombin time

ISDT:

Immune suppressive drug therapy

R-CHOP:

Rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone

TACE:

Transarterial chemoembolization

TNF:

Tumor necrosis factor

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Authors and Affiliations

  1. Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center, 1250 8th Avenue, Suite 515, Fort Worth, TX, 76104, USA

    Stevan A. Gonzalez M.D., M.S.

  2. Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth Street, Suite 960, Dallas, TX, 75246, USA

    Robert P. Perrillo M.D.

Authors
  1. Stevan A. Gonzalez M.D., M.S.
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  2. Robert P. Perrillo M.D.
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Correspondence to Stevan A. Gonzalez M.D., M.S. .

Editor information

Editors and Affiliations

  1. Chang Gung University, Chang Gung Memorial Hospital, Taipei, Taiwan

    Yun-Fan Liaw

  2. INSERM Unit 1052, Hospices Civils de Lyon, Lyon University, Lyon, France

    Fabien Zoulim

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© 2016 Springer International Publishing Switzerland

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Gonzalez, S.A., Perrillo, R.P. (2016). Reactivation of Hepatitis B Virus Due to Cancer Chemotherapy and Other Immunosuppressive Drug Therapy. In: Liaw, YF., Zoulim, F. (eds) Hepatitis B Virus in Human Diseases. Molecular and Translational Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-22330-8_18

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  • DOI: https://doi.org/10.1007/978-3-319-22330-8_18

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-22329-2

  • Online ISBN: 978-3-319-22330-8

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