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- Title
Clinical characteristics and molecular analysis of hepatitis B virus reactivation in hepatitis B surface antigen-negative patients during or after immunosuppressive or cytotoxic chemotherapy.
- Authors
Hayashi, Kazuhiko; Ishigami, Masatoshi; Ishizu, Yoji; Kuzuya, Teiji; Honda, Takashi; Tachi, Yoshihiko; Ishikawa, Tetsuya; Katano, Yoshiaki; Yoshioka, Kentaro; Toyoda, Hidenori; Kumada, Takashi; Goto, Hidemi; Hirooka, Yoshiki
- Abstract
<bold>Background and Aim: </bold>Reactivation of hepatitis B virus (HBV) in hepatitis B surface antigen (HBsAg)-positive patients treated with immunosuppressive or cytotoxic chemotherapy is well known and has emerged as an important clinical issue. The risk is low, but reactivation of HBV in HBsAg-negative patients after resolution of HBV infection also occurs; however, the clinical and virological characteristics remain somewhat unclear. We investigated HBsAg-negative patients who developed HBV reactivation during or after immunosuppressive or cytotoxic chemotherapy to clarify the clinical and virological features.<bold>Methods: </bold>Reactivation of HBV in 30 previously infected that is HBsAg-negative patients during or after immunosuppressive or cytotoxic chemotherapy was examined. Direct sequencing at the time of reactivation was used to evaluate 11 patients.<bold>Results: </bold>The majority of patients had diffuse large B cell lymphoma treated by rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone. Fulminant hepatic failure developed in three patients, who did not survive. HBV subgenotypes A2/Ae (n = 1), B1/Bj (n = 2), and C2/Ce (n = 8) were detected. There were no significant differences in the prevalence of BCP/PC variants between HBV reactivation and acute self-limited hepatitis patient groups. BCP and PC variants were not associated with development of fulminant hepatic failure from HBV reactivation. The prevalence of HBV S region variants, including immune-escape mutants, among reactivation patients was significantly higher than that in acute self-limited hepatitis patients.<bold>Conclusions: </bold>Reactivation risk factors included male sex, advanced age, and hematological malignancy. HBV S gene immune-escape mutants were frequently found in the HBsAg-negative reactivation patients during or after immunosuppressive or cytotoxic chemotherapy.
- Subjects
HEPATITIS B treatment; ANTINEOPLASTIC agents; HEPATITIS associated antigen; IMMUNOSUPPRESSIVE agents; DRUG therapy; MOLECULAR virology
- Publication
Journal of Gastroenterology, 2016, Vol 51, Issue 11, p1081
- ISSN
0944-1174
- Publication type
journal article
- DOI
10.1007/s00535-016-1187-z