Reactivated hepatitis B is a potentially serious disorder that can result in liver failure and death. It has been described with a wide variety of immunosuppressive interventions, such as cancer chemotherapy, anti-rejection drugs and the use of tumour necrosis factor-α inhibitors and monoclonal antibody to B-cell antigen. It now appears reasonable to consider transarterial chemoembolization (TAC) for hepatocellular carcinoma as an additional medical intervention associated with hepatitis B reactivation. Pre-emptive antiviral treatment of hepatitis B surface antigen (HBsAg) carriers can prevent serious complications arising from immunosuppressive-induced viral reactivation. Specific recommendations for antiviral prophylaxis in HBsAg carriers undergoing TAC should be added to international management guidelines.
References
1.
HoofnagleJ.H.Reactivation of hepatitis B. Hepatology2009; 49Suppl 5: S156–S165.
2.
NagingtonJ., CossartY., CohenB.J.Reactivation of hepatitis B after transplantation operations. Lancet1977; 309: 558–560.
3.
GalbraithR.M., WilliamsR., EddlestonA.L.W.F., ZuckermanA.J., BagshaweK.D.Fulminant hepatic failure in leukaemia and choriocarcinoma related to withdrawal of cytotoxic drug therapy. Lancet1975; 306: 528–530.
4.
Tur-KaspaR., BurkR.D., ShaulY., ShafritzD.A.Hepatitis B virus DNA contains a glucocorticoid-responsive element. Proc Natl Acad Sci U S A1986; 83: 1627–1631.
5.
HoofnagleJ.H., DavisG.L., PappasS.C.A short course of prednisolong in chronic type B hepatitis. Report of a randomized, double-blind, placebo-controlled trial. Ann Intern Med1986; 104: 12–17.
6.
LokA.S.F., LiangR.H.S., ChiuE.K.W., WondK-L, ChanT-K, ToddD.Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology1991; 100: 182–188.
7.
HuiC.K., CheungW.W.W., ZhangH.Y.Kinetics and risk of de novo hepatitis B infection in HBsAg-negative patients undergoing cytotoxic chemotherapy. Gastroenterology2006; 131: 59–68.
8.
YeoW., ChanP.K.S., ZhongS.Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: A prospective study of 626 patients with identification of risk factors. J Med Virol2000; 62: 299–307.
9.
CarrollM.B., ForigineM.A.Use of tumor necrosis factor α inhibitors in hepatitis B surface antigen-psoitive patients: a literature review and potential mechanisms of action. Clin Rheumatol2010; 29: 1021–1029.
10.
MoriscoF., CastiglioneF., RispoA.Hepatitis B virus reactivation and immunosuppressive therapy in patients with inflammatory bowel disease. Dig Liver Dis2011; 43Suppl 1: S40–S48.
11.
KooY.X., TayM., TehY.E.Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/hepatitis B core antibody positive patients receiving rituximab-containing combination chemotherapy without routine antiviral prophylaxis. Ann Hematol2011; doi: 10.1007/s00277-011-1241-0.
12.
PerrilloR.P.Acute fares in chronic hepatitis B: the natural and unnatural history of an immunologically mediated liver disease. Gastroenterology2001; 120: 1009–1022.
13.
YeoW., ZeeB., ZhongS.Comprehensive analysis of risk factors associating with hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy. Br J Cancer2004; 90: 1306–1311.
14.
YeoW., ChanP.K.S., ZhongS.Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors. J Med Virol2000; 62: 299–307.
15.
ChengA-L, HsiungC-A, SuI-J. Lymphoma Committee of Taiwan Cooperative Oncology Group (TCOG). Steroid free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma. Hepatology2003; 37: 1320–1328.
16.
JangJ.W., KwonH.J., YouC.R.Risk of reactivated HBV reactivation according to viral status and treatment intensity in patients with hepatocellular carcinoma. Antivir Ther2011; doi:10.3851/IMP1840.
17.
LencioniR.Loco-regional treatment of hepatocellular carcinoma. Hepatology2010; 52: 762–773.
LammerJ., MalagariK., VoglT.Prospective randomized study of doxorubicin-eluting bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol2010; 33: 41–52.
