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Reactivation of hepatitis B virus in HBsAg-negative patients with hepatocellular carcinoma.

Jang JW, Kim YW, Lee SW, Kwon JH, Nam SW, Bae SH, Choi JY, Yoon SK, Chung KW - PLoS ONE (2015)

Bottom Line: TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment.TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation.Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background & aims: Despite increasing attention to hepatitis B virus (HBV) reactivation in hematologic settings, information on reactivation in hepatitis B surface (HBsAg)-negative patients with hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine the incidence and risk factors of HBV reactivation in HBsAg-negative patients undergoing transarterial chemoembolization (TACE).

Methods: A total of 109 HBsAg-negative patients with HCC were consecutively recruited for this study and treated with either mono- (n = 75), combination-drug TACE (n = 20), or combination-drug TACE plus radiotherapy (n = 14). With serial monitoring of virological markers every 2-3 months, patients were observed for HBV reactivation (defined as the reappearance of HBV DNA or sero-reversion of HBsAg) in comparison with control subjects with HBsAg-negative cirrhosis (n = 16) or HBsAg loss (n = 46).

Results: During the study period, HBV reactivation occurred in 12 (11.0%) and 1 (1.6%) patients in the TACE and control groups, respectively. The median level of HBV DNA at reactivation was 5,174 copies/ml (range: 216-116,058). Of the 12 patients with HBV reactivation, four (33.3%) developed clinical hepatitis, including one patient who suffered from decompensation. All antiviral-treated patients achieved undetectable HBV DNA or HBsAg loss after commencement of antiviral drugs. TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment. On multivariate analysis, treatment intensity and a prior history of chronic hepatitis B remained independently predictive of reactivation.

Conclusions: TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation. Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation.

No MeSH data available.


Related in: MedlinePlus

A and B, Clinical hepatitis associated with HBV reactivation according to treatment intensity.(A) ALT levels at HBV reactivation in reactivated patients (P = 0.321). (B) Hepatitis due to HBV reactivation according to treatment intensity among the entire patient group with HCC. The incidence rates of reactivation hepatitis were 1.3% (1/75) for mono-TACE, 5.0% (1/20) for combo-TACE, and 14.3% (2/14) for combo + RT (P for trend = 0.021).
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pone.0122041.g003: A and B, Clinical hepatitis associated with HBV reactivation according to treatment intensity.(A) ALT levels at HBV reactivation in reactivated patients (P = 0.321). (B) Hepatitis due to HBV reactivation according to treatment intensity among the entire patient group with HCC. The incidence rates of reactivation hepatitis were 1.3% (1/75) for mono-TACE, 5.0% (1/20) for combo-TACE, and 14.3% (2/14) for combo + RT (P for trend = 0.021).

Mentions: The clinical features of the 13 patients with reactivation are shown in Table 3. Overall, 4 (30.8%) patients in the TACE group and none in the control group developed clinical hepatitis due to HBV reactivation during follow-up. For HCC patients with HBV reactivation, the median times elapsed to HBV reactivation and reactivation hepatitis were 6.77 months (range: 3.0–18.93) from initiation of TACE and 84.5 (range: 41–443) days from the onset of viral reactivation, respectively. The median levels of HBV DNA and ALT for the 12 HCC patients with HBV reactivation were 5,174 copies/ml (range: 216–116,058) and 74 IU/L (range: 40–332) at the time of HBV reactivation. The levels of ALT and incidence of hepatitis due to HBV reactivation tended to correlate positively with the type of TACE, with a higher risk of hepatic events with increasing TACE intensity (Fig 3A and 3B).


Reactivation of hepatitis B virus in HBsAg-negative patients with hepatocellular carcinoma.

Jang JW, Kim YW, Lee SW, Kwon JH, Nam SW, Bae SH, Choi JY, Yoon SK, Chung KW - PLoS ONE (2015)

A and B, Clinical hepatitis associated with HBV reactivation according to treatment intensity.(A) ALT levels at HBV reactivation in reactivated patients (P = 0.321). (B) Hepatitis due to HBV reactivation according to treatment intensity among the entire patient group with HCC. The incidence rates of reactivation hepatitis were 1.3% (1/75) for mono-TACE, 5.0% (1/20) for combo-TACE, and 14.3% (2/14) for combo + RT (P for trend = 0.021).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4403914&req=5

pone.0122041.g003: A and B, Clinical hepatitis associated with HBV reactivation according to treatment intensity.(A) ALT levels at HBV reactivation in reactivated patients (P = 0.321). (B) Hepatitis due to HBV reactivation according to treatment intensity among the entire patient group with HCC. The incidence rates of reactivation hepatitis were 1.3% (1/75) for mono-TACE, 5.0% (1/20) for combo-TACE, and 14.3% (2/14) for combo + RT (P for trend = 0.021).
Mentions: The clinical features of the 13 patients with reactivation are shown in Table 3. Overall, 4 (30.8%) patients in the TACE group and none in the control group developed clinical hepatitis due to HBV reactivation during follow-up. For HCC patients with HBV reactivation, the median times elapsed to HBV reactivation and reactivation hepatitis were 6.77 months (range: 3.0–18.93) from initiation of TACE and 84.5 (range: 41–443) days from the onset of viral reactivation, respectively. The median levels of HBV DNA and ALT for the 12 HCC patients with HBV reactivation were 5,174 copies/ml (range: 216–116,058) and 74 IU/L (range: 40–332) at the time of HBV reactivation. The levels of ALT and incidence of hepatitis due to HBV reactivation tended to correlate positively with the type of TACE, with a higher risk of hepatic events with increasing TACE intensity (Fig 3A and 3B).

Bottom Line: TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment.TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation.Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background & aims: Despite increasing attention to hepatitis B virus (HBV) reactivation in hematologic settings, information on reactivation in hepatitis B surface (HBsAg)-negative patients with hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine the incidence and risk factors of HBV reactivation in HBsAg-negative patients undergoing transarterial chemoembolization (TACE).

Methods: A total of 109 HBsAg-negative patients with HCC were consecutively recruited for this study and treated with either mono- (n = 75), combination-drug TACE (n = 20), or combination-drug TACE plus radiotherapy (n = 14). With serial monitoring of virological markers every 2-3 months, patients were observed for HBV reactivation (defined as the reappearance of HBV DNA or sero-reversion of HBsAg) in comparison with control subjects with HBsAg-negative cirrhosis (n = 16) or HBsAg loss (n = 46).

Results: During the study period, HBV reactivation occurred in 12 (11.0%) and 1 (1.6%) patients in the TACE and control groups, respectively. The median level of HBV DNA at reactivation was 5,174 copies/ml (range: 216-116,058). Of the 12 patients with HBV reactivation, four (33.3%) developed clinical hepatitis, including one patient who suffered from decompensation. All antiviral-treated patients achieved undetectable HBV DNA or HBsAg loss after commencement of antiviral drugs. TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment. On multivariate analysis, treatment intensity and a prior history of chronic hepatitis B remained independently predictive of reactivation.

Conclusions: TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation. Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation.

No MeSH data available.


Related in: MedlinePlus