Reactivation risk of Hepatitis B Virus in both HBsAg negative and HBcIgG positive patients with solid malignancy. Is antiviral prophylaxis really necessary?

Prophylactic antiviral treatment is controversial due to a lack of studies in both HBsAg negative/HBcIgG positive patients who treated conventional chemotherapy with solid malignancy, unlike HBsAg positive. In this cross-sectional and retrospective study, we analyzed that the reactivation risk of Hepatitis B Virus (HBVr) of totally 457 HBcIgG positive patients with solid cancer in archives records between 2011 and 2018 years of two different centers. Totally 217 HBcIgG positive patients with solid cancer were included in the study. Anti-HBs positive and negative patients were 119 (54.8%) and 98 (45.2%), respectively. Frequent diagnosis of the patients was lung (28.1%), colorectal (19.4%), breast (17.5%) and hepatobiliary tract cancers (8.3%), respectively. Most of the study population had stage 4 disease (48.8%) and received palliative chemotherapy. When the patients were stratified due to American Gastroenterological Association Institute (AGA) guideline, HBVr risk of chemo regimen was moderate in 21 patients (17.5%), low in 8 patients (3.7%). The majority of the patients were undefined risk group (78.8%). We did not determine any HBVr in the patients who have received different conventional chemotherapy regimens and have different primer tumor site despite all the patients did not receive the prophylactic antiviral drug.

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Borentain P, Colson P, Coso D, et al. Clinical and virological factors associated with hepatitis B virus reactivation in HBsAg-negative and anti-HBc antibodies-positive patients undergoing chemotherapy and autologous stem cell transplantation for cancer. J Viral Hepat. 2010;17:807-15.

Aygen B, Demir AM, Gumuş M, et al. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol 2018;29:259-69.

Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219-37.

Cholongitas E, Haidich A, Apostolidou-kiouti F, et al. Hepatitis B virus reactivation in HBsAg-negative , anti-HBc-positive patients receiving immunosuppressive therapy: a systematic review. 2018;480-90.

Voican CS, Mir O, Loulergue P, et al. Hepatitis B virus reactivation in patients with solid tumors receiving systemic anticancer treatment. Ann Oncol. 2016;27:2172-84.

Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215-9.

Paul S, Saxena A, Terrin N, et al. Hepatitis b virus reactivation and prophylaxis during solid tumor chemotherapy: A systematic review and meta-analysis. Ann Intern Med. 2016;164:30-40.

Xu Z, Dai W, Wu YT, et al. Prophylactic effect of lamivudine on chemotherapy-induced hepatitis B virus reactivation in patients with solid tumour: A meta-analysis. Eur J Cancer Care (Engl). 2018;27:e12799.

Wu T, Kwok RM, Tran TT. Isolated anti-HBc: The Relevance of Hepatitis B Core Antibody—A Review of New Issues. Am J Gastroenterol. 2017;112:1780-8.

Fukuda W, Hanyu T, Katayama M, et al. Incidence of hepatitis B virus reactivation in patients with resolved infection on immunosuppressive therapy for rheumatic disease: A multicentre, prospective, observational study in Japan. Ann Rheum Dis. 2017;76:1051-6.

Feld JJ. Hepatitis B Reactivation: The Controversies Continue. Dig Dis. 2017;35:351–8.