Lamivudine and glycyrrhizin for treatment of chemotherapy-induced hepatitis B virus (HBV) hepatitis in a chronic HBV carrier with non-Hodgkin lymphoma

We report a chronic hepatitis B virus (HBV) carrier with non-Hodgkin lymphoma (NHL) who developed HBV hepatitis following conventional dose chemotherapy and was successfully treated with lamivudine and glycyrrhizin. A 55 year-old male patient with primary testicular NHL (diffuse large B-cell type) relapsed. During the salvage chemotherapy, the patient showed elevated serum levels of transaminase and HBV-DNA due to HBV reactivation. Treatment with lamivudine, an antiviral nucleoside analog, was started at a dose of 100mg/day. Shortly after the treatment the HBV-DNA level was suppressed, and sustained elevation of transaminase levels were normalized after additional treatment with glycyrrhizin. This experience suggests that lamivudine combined with glycyrrhizin may be effective for controlling HBV replication and treating chemotherapy-induced HBV hepatitis in chronic HBV carriers with NHL.     

Hepatitis B reactivation in patients positive for hepatitis B surface antigen undergoing autologous hematopoietic cell transplantation

Hepatitis due to reactivation of hepatitis B virus is an important cause of liver-related morbidity and mortality in hepatitis B surface antigen (HBsAg) positive patients undergoing autologous hematopoeitic cell transplantation. With the recent introduction of sensitive serum HBV DNA quantitation assay, the diagnosis of hepatitis B reactivation can now be made more reliably. As these hepatitis are driven by the host immune response to a surge of hepatitis B viral load, the availability of effective nucleoside analogues which can inhibit hepatitis B viral replication has opened up new approaches to this previously untreatable condition. Up till now, two such nucleoside analogues, lamivudine and adefovir dipivoxil, have been approved for the treatment of chronic hepatitis B infection. However, further studies are needed to determine which nucleoside analogues should be chosen in this transplant setting. Due to the high dose chemotherapy generally needed in autologous hematopoeitic cell transplantation, there is a high risk of post-transplant hepatitis B reactivation. Hence, all HBsAg positive patients undergoing autologous hematopoeitic cell transplantation should preferably be treated pre-emptively with nucleoside analogous. An alternative approach is to defer treatment with nucleoside analogous until there is evidence of hepatitis B virological reactivation. However, the latter approach would need the patient's hepatitis B viral load be monitored at a very close interval and might not be cost-effective.     

Hepatitis B virus reactivation in adjuvant chemotherapy for breast cancer

Immunosuppressive therapy, such as chemotherapy or the use of corticosteroids, may stimulate reactivation of hepatitis B virus (HBV). Most of these episodes occur in patients whose hepatitis B surface antigens are positive (HBsAg+). We report a case of HBV reactivation in a patient with negative HBsAg during chemotherapy for breast cancer, in spite of avoiding corticosteroids. A 68-year-old woman received adjuvant chemotherapy for breast cancer. Her serological examinations showed that HBsAg, HBeAg, and HBV-DNA were all negative. Her chemotherapy consisted of CAF (cyclophosphamide 500 mg/m², doxorubicin 50 mg/m², fluorouracil 500 mg/m²) without administration of corticosteroids. She received six cycles of CAF. At day 27 after her sixth CAF, she was admitted to the hospital with acute hepatitis B virus (HBV) reactivation. She received glycyrrhizinic acid by intravenous injection (80 mg/day), ursodeoxycholic acid (300 mg/day), and entecavir (0.5 mg/day). Then she received interferon by intravenous injection (3 million units/day), prednisolon by intravenous injection (45 mg/day), and plasma exchange therapy. However, she died of liver failure. This is a rare case in which HBV reactivation occurred in an HBsAg negative patient during chemotherapy without using corticosteroids. This episode suggests that HBV reactivation may occur during chemotherapy in any patient with a history of HBV infection. Therefore, we recommend checking HBsAg, HBsAb, and HBcAb before starting chemotherapy. Moreover, with positive HBsAb or/and HBcAb patients, HBV-DNA should be checked before starting chemotherapy and monitored during chemotherapy by a sensitive PCR method.     

异基因造血干细胞移植中供受体乙肝病毒感染的意义

 目的 分析白血病患者移植前供、受者感染乙型肝炎病毒（HBV）对异基因造血干细胞移植（allo-HSCT）临床结果的影响。方法 对该院1996年5月至2005年2月间进行的31例合并HBV感染的HSCT患者临床资料进行回顾性分析。结果 31例受者均达到造血干细胞植活,乙型肝炎指标供者阳性、受者阴性8例,其中1例26个月死于肝硬化,2例在免疫抑制剂停用后,发展为慢性活动性肝炎;乙型肝炎指标供者阴性、受者阳性20例,其中2例乙型肝炎指标转阴,5例获得HBsAb（+）,4例移植后HBcAb转阴及HBeAb转阴,仅HBsAb（+）,1例转为"HBsAg（+）、HBeAg（+）、HBcAb（+）";乙型肝炎指标供者、受者均阳性3例,1例患者并发肝静脉闭塞病（VOD）,1例获得一过性HbsAg（+）,1例获得HbsAb（+）。结论 HBV感染对干细胞植活时间无明显影响;供、受者感染乙肝病毒不是HSCT的绝对禁忌证;HBsAg（+）及HBV滴度是影响移植后乙型肝炎复发的重要因素;HBsAg（+）的患者可作为HbsAb（+）受者的供者,但对HbsAb（-）受者则应慎重;拉米夫定及乙肝免疫球蛋白联合应用较乙肝疫苗单独使用更能有效地控制HBsAg（+）的供受者在移植后的乙型肝炎疾病的进展;HSCT有可能通过过继免疫治疗乙型肝炎。     

Why, when, and how to prevent hepatitis B virus reactivation in cancer patients undergoing chemotherapy

Hepatitis B virus (HBV) reactivation is a serious clinical problem in HBV carriers undergoing chemotherapy. The clinical course of HBV reactivation can be separated into 2 phases: 1) an increase in HBV replication and 2) hepatic injury. Patients with resolved HBV infections (negative for hepatitis B surface antigen [HBsAg], and positive for both hepatitis B core antibody [anti-HBc] and/or hepatitis B surface antibody) can experience HBV reactivation, and Western guidelines recommend that not only HBsAg but also anti-HBc be screened before initiation of chemotherapy or immunosuppressive therapy. Several meta-analyses have repeatedly confirmed the prophylactic role of lamivudine in preventing HBV reactivation. In conclusion, screening for HBV is required before chemotherapy, and prophylactic antiviral therapy can reduce not only the incidence of HBV reactivation but also HBV-related morbidity and mortality.     

HBsAg阴性HBcAb阳性肿瘤患者化疗后HBV再激活3例报道并文献复习

目的：探讨乙肝表面抗原（HBsAg）（-）核心抗体（HBcAb）（+）肿瘤患者化疗后引起乙型肝炎病毒（HBV）再激活的治疗与监控。方法：报道3例HBsAg（-）HBsAg（+）的肿瘤患者化疗过程中出现HBV再激活的病例,针对可行的治疗监控措施进行文献复习。结果：1例最初乙肝表面抗体（HBsAb）（+）、HBcAb（+）的非霍奇金淋巴瘤（NHL）患者经过多次化疗后转变为HBsAg（+）、e抗原（HBeAg）(+)、HBcAb（+）;1例乙肝e抗体（HBsAb）（+）、HBcAb(+)的霍奇金淋巴瘤（NL）患者化疗后乙肝模式未改变,乙肝病毒载量（HBV-NDA）定量结果增高;1例HBsAb(+)、HBeAb(+)、HBcAb(+)的肝癌患者性肝动脉化疗栓塞术（TACE）后出现HBV-DNA定量结果增高。3例HBsAg(-)患者化疗后均出现HBV再激活,经抗病毒治疗后获得良好转归。结论：不仅对于HBsAg（+）的患者,对于即使处于康复期的既往有急性或慢性乙肝病史的HBsAg(-)、HBcAb（+）患者,在应用化疗或免疫抑制剂治疗时均需严密监测血清HBsAg、肝功能及HBV-DNA定量的动态变化,必要时实施预防性抗病毒治疗,以免中止原有治疗计划延误病情。     

拉米夫定预防B细胞非霍奇金淋巴瘤患者利妥昔单抗化疗后乙型肝炎病毒再激活的临床分析

 【摘要】　目的　研究利妥昔单抗联合化疗治疗B细胞非霍奇金淋巴瘤（B-NHL）合并乙型肝炎病毒（HBV）携带患者的安全性,探讨拉米夫定预防性治疗的价值。方法　回顾性分析含利妥昔单抗联合化疗前后B-NHL患者乙型肝炎五项、HBV-DNA和肝功能指标变化。将39例HBV核心抗体（HBcAb）（+）／HBV表面抗体（HBsAb）（-）的B-NHL患者分为拉米夫定预防组和对照组,比较两组化疗后HBV再激活、肝功能损害等指标。结果　108例接受利妥昔单抗联合化疗的B-NHL患者中,15例患者为HBV表面抗体（HBsAg）（+）,占所有患者的13.89 %;39例为HBsAg（-）／HBcAb（+）患者,占所有患者的36.11 %。15例HBsAg（+）的患者中HBV再激活率为13.3 %,13例拉米夫定预防患者中1例（7.7 %）HBV再激活,2例未预防的患者中1例HBV再激活。39例HBsAg（-）／HBcAb（+）患者中HBV再激活率为7.7 %（3例）,14例拉米夫定预防组HBV再激活率为0,25例未预防的患者中3例（12 %）HBV再激活。结论　B-NHL合并HBV携带患者在利妥昔单抗联合化疗导致HBV再激活的风险是可控的,预防性使用拉米夫定能明显降低HBV再激活。     

Use of ALLGIO Probe Assays for Detection of HBV Resistance to Adefovir in Patients with Chronic Hepatitis B,Kerman, Iran

Hepatitis B virus (HBV) infection is contagious with transmissiobn vertically or horizontally by blood productsand body secretions. Over 50% of Iranian carriers contracted the infection prenatally, making this the mostlikely route of transmission of HBV in Iran. To evaluate the resistance to adefovir (ADV) therapy in patients withchronic hepatitis B infection, a study was conducted on 70 patients (63 males and 7 females), who had receivedin first line lamivudine and second line adefovir. All were tested for the presence of hepatitis B surface antigen(HBsAg), hepatitis B envelope antigen (HBeAg), serum alanine amino transferase (ALT) level and HBV DNAload before and after treatment with ADV. In all samples, resistance to lamivudine and ADV was tested withreal time PCR. Among seventy patients with chronic hepatitis B infection, 18 (25.7%) were resistant to LAMand 8 (11.4%) were resistant to ADV. Only one patient was negative for the presence of HBS-Ag (5.6%) andtwo were negative for HBe-Ag (11.1%). In this study we used a new method (ALLGIO probe assay) that hashigh sensitivity in detection of adefovir resistance mutants, which we recommend to other researchers. Mutantstrains of the YMDD motif of HBV polymerase can be found in some patients under treatment with lamivudineand ADV. ADV has been demonstrated to be efficient in patients with lamivudine resistant HBV.     

Reactivation of hepatitis B virus infection with cytotoxic therapy in non-Hodgkin’s lymphoma

In patients with non-Hodgkin's lymphoma (NHL), there are some well-known tumor-related adverse prognostic factors that may increase the mortality rate. However, secondary factors such as viral hepatitis carriers that may decrease the cure rates are usually ignored. Reactivation of hepatitis B virus (HBV) infection in patients undergoing cytotoxic treatment for NHL is a well-known complication. Charts of 112 patients with NHL were retrospectively analyzed regarding their hepatitis serology, the indirect effects of seropositivity on disease outcome, and the precautions undertaken in these seropositive patients with NHL. Twelve patients (11%) with HBsAg positivity and two patients (1.7%) with antibody to hepatitis C virus positivity were detected. Eight out of 12 patients (67%) with HBsAg positivity and two patients (50%) with anti-HCV positivity showed reactivation of hepatitis during treatment of NHL. No reactivation was detected in four patients seropositive for HBV, who were given lamivudine prophylaxis before the initiation of chemotherapy schedules. Among patients with hepatitis reactivation, two were treated with lamivudine resulting in dramatic improvement and clinical remission of the disease. The remaining six patients with reactivation were left untreated, resulting in four deaths (67%) due to liver failure secondary to HBV and two deaths secondary to delayed treatment of NHL. One patient seropositive for anti-HCV also developed chronic hepatitis C. Determination of hepatitis serology in all patients with NHL before any chemotherapy administration is crucial, but insufficient, if not taken into consideration. In seropositive patients, HBV DNA should be determined and antiviral prophylaxis with lamivudine should be initiated before any treatment.     

多发性骨髓瘤与乙型肝炎病毒感染的临床观察

目的 探讨多发性骨髓瘤（MM）患者乙型肝炎病毒（HBV）的感染状况及乙肝表面抗原（HBsAg）阳性MM患者的临床特点。方法 应用ELISA法测定196例MM患者以及48 697例健康体检者（对照组）的HBV标记物,PCR法测定HBV-DNA拷贝数。结果 196例MM 患者中HBsAg阳性者有5例（2.6％）,与对照组的3.4%比较差异无统计学意义（P>0.05）。5例HBsAg阳性MM患者的HBV血清学标记均为HBsAg、HBeAb、HBcAb三者阳性,其中2例HBV-DNA拷贝数＞1000,给予拉米夫定治疗。5例患者均给予抗MM治疗,未见HBV激活和肝功能异常。结论 HBV感染可能与MM发病无关,抗MM治疗对HBV的病毒激活及肝功能的影响可能不明显,仍有待于进一步研究。     

Hepatitis B virus reactivation in hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization therapy

Aim: The effect of transcatheter arterial chemoembolization (TACE) therapy on hepatitis B virus (HBV) reactivation in hepatocellular carcinoma (HCC) patients with prior resolved hepatitis B is not fully understood. Methods: From January 2006 to December 2010, 43 hepatitis B surface antigen (HBsAg)‐negative/anti‐hepatitis B core antigen (HBc) positive patients with newly diagnosed unresectable HCC were enrolled in the study. All underwent TACE therapy. Results: Four patients (9.3%) developed HBV reactivation with mild/moderate hepatitis. The median number of TACE cycles received was 3.5 (range 3–4 cycles). The median time interval between the occurrence of HBV reactivation and the completion of TACE therapy was 3 months (range 1–5 months) and their median HBV DNA level was 1.58 × 10⁴ IU/mL (range, 1.65 × 10³–6.42 × 10⁴ IU/mL). After the introduction of lamivudine at the occurrence of HBV reactivation, all had resolution of hepatitis. An exploratory analysis indicated that significant predictors of HBV reactivation included increased serum total bilirubin coexisting with cirrhosis and the total number of cycles of TACE received. Conclusion: The administration of TACE therapy may increase the risk of HBV reactivation in HBsAg‐negative/anti‐HBc‐positive patients diagnosed with unresectable HCC. Further studies are warranted to explore the optimal management of HBV reactivation in patients with prior resolved hepatitis B.     

Prophylaxis with lamivudine of hepatitis B virus reactivation in chronic HbsAg carriers with hemato-oncological neoplasias treated with chemotherapy

Reactivation of hepatitis B virus (HBV) infection is well documented complication of cytotoxic or immunosuppressive therapy in asymptomatic HBV carriers. Its clinical manifestation include fulminant hepatitis which may result in fatal liver failure. With the more widespread use of chemotherapy and hematopoietic stem cell transplantation, the problem of delivering potentially harmful treatment to HBV carriers is becoming increasingly frequent. Until recently the management of HBV reactivation has been mainly supportive. With the introduction of lamivudine, a highly effective nucleoside analogue against HBV with an excellent toxicity profile has become available. However, in light of the possibility that its prolonged use may foster the emergence of mutant lamivudine-resistant HBV strain, caution is required before recommending its widespread use. The present review briefly addresses the epidemiological, pathogenetic and clinical aspects of HBV reactivation as well the predisposing factors to its development. The results obtained with lamivudine both as treatment and as prophylaxis of hepatic flares are analysed in detail in order to provide a rational basis for clinical decisions before treating HBV carriers with chemotherapy.     

Hepatitis B virus reactivation associated with temozolomide for malignant glioma: a case report and recommendation for prophylaxis

Hepatitis B virus (HBV) reactivation during anticancer chemotherapy or immunosuppressive therapy in chronic carriers can lead to fatal liver failure. We report a rare case of severe HBV reactivation during postoperative radiotherapy with concomitant and adjuvant temozolomide (TMZ) for malignant glioma. A 49-year-old Japanese woman with a history of HBV carrier status with positive results for hepatitis B surface antigen presented with persistent headache due to a tumor in the left frontal lobe. The tumor was partially resected and anaplastic astrocytoma was diagnosed. Postoperative liver function was normal and radiotherapy plus concomitant and adjuvant TMZ was started. Impaired liver function became apparent just before administration of adjuvant TMZ, and acute liver failure developed. Antiviral therapy including entecavir, a nucleoside analog, led to a successful outcome and the patient survived. This case underlines the possibility of HBV reactivation due to TMZ and suggests the utility of HBV screening and antiviral prophylaxis before administration of TMZ to patients with malignant glioma.     

A case of the usage of entecavir to prevent hepatitis B virus reactivation during chemotherapy in breast cancer patient

Hepatitis B virus(HBV)reactivation is a serious clinical problem for HBV infected patients, and one of its possible causes is chemotherapy for malignant disease. At the onset of active hepatitis, planned chemotherapy should be discontinued and acute or fetal fulminant hepatitis must be induced in some cases. Therefore, it is desirable to prevent virus reactivation during chemotherapy in HBV-positive patients. We report a case in which adjuvant chemotherapy for a breast cancer patient was accomplished safely by using entecavir. The patient was a 48-year-old woman with breast cancer whose HBV infection had been pointed out when she was 20 years old. Breast reconstruction was performed, followed by mastectomy. Pathological findings were invasive ductal carcinoma, three positive nodes, estrogen and progesterone receptor-positive, and HER2-negative. An adjuvant chemotherapy with anthracycline followed by taxane was planned. Blood chemistry revealed the seroconversion of HBV and the quantity of HBV-DNA was 2. 8 log copies/mL. Administration of the anti-virus agent, entecavir, was started three weeks before chemotherapy. The HBV-DNA was decreased under the titer of detection and no re-increase in HBV-DNA was found during chemotherapy. Planned chemotherapy was accomplished safely without HBV reactivation.     

Chemotherapy and bone marrow transplantation for cancer patients who are also chronic hepatitis B carriers: a review of the problem.

In places where hepatitis B virus (HBV) infection is endemic, it is often necessary to give chemotherapy to or perform bone marrow transplantation for cancer patients who are also chronic HBV carriers. When standard chemotherapy was given to lymphoma patients, elevation of liver transaminases was observed in nearly half of those who were chronic HBV carriers. Ten percent of them became jaundiced, and the overall liver-related mortality was about 5%. There is currently no reliable way to predict the severity of HBV reactivation after chemotherapy. The risk is probably higher when the chemotherapy used is significantly immunosuppressive and the viral load in the liver is high. Different strategies have been used in an attempt to reduce the risk of HBV reactivation after chemotherapy, but they have not been very successful. Further studies will be required to determine the impact of newly available antiviral agents that are active against HBV. Recipients who are carriers of HBV or who receive hepatitis B surface antigen (HBsAg)-positive marrow are at increased risk of hepatitis B-related morbidity and mortality after bone marrow transplantation (BMT). There is evidence to suggest that prophylactic use of an active antiviral agent, such as famciclovir, may result in a significant decrease in the incidence and severity of HBV reactivation after BMT. Sustained serologic clearance of chronic HBV infection has also been reported in many HBsAg-positive marrow recipients receiving hepatitis B surface antibody-positive marrow from their allogeneic donors. There seems to be a transfer of both humoral and cellular immunity against HBV from donors to recipients. Further prospective studies are required to define the best approach to manage HBsAg-positive cancer patients receiving chemotherapy or BMT. It is recommended that all cancer patients be checked for their hepatitis B status before receiving chemotherapy or a bone marrow transplant, especially if they reside in or come from endemic areas of HBV infection.     

High hepatitis B virus infection in B-cell lymphoma tissue and its potential clinical relevance

Our previous studies found that patients with B-cell non-Hodgkin lymphoma (NHL) had a higher incidence of hepatitis B virus (HBV) infection in serum than patients with T-cell NHL or other cancers. We sought to identify a possible role of HBV infection in B-cell NHL tumorigenesis and to understand its underlying clinical relevance. Fresh and paraffin-embedded primary tumor tissue from patients with NHL as well as from those with other lymphatic system diseases were investigated by PCR and immunohistochemistry. Many more patients with B-cell lymphoma whose serum was positive for hepatitis B surface antigen (HBsAg) were also positive for HBV-DNA than were those with T-cell NHL or other lymphatic system diseases whose serum was positive for HBsAg, in both fresh (55 vs. 15.4%) and paraffin-embedded (38.3 vs. 11.8%) tissue. Positive expression of the HBV-associated proteins HBsAg and hepatitis B core antigen was found in B-cell NHL lymphocytes and endothelial cells. Only 8.3% of patients with B-cell NHL who were negative for HBsAg but positive for other HBV markers were positive for HBV-DNA in tumor tissue. These results suggest that chronic HBV infection in lymph nodes could be associated with B-cell lymphoma.     

抗病毒治疗对合并肝炎肝癌术后的影响

目的观察拉米夫定结合胸腺肽抗病毒治疗对合并肝炎肝癌术后的复发和生存时间影响。方法2000年1月-2003年12月,70例合并肝炎肝癌随机分为两组。对照组为手术切除组(n=35),治疗组(n=35)为手术切除加术后拉米夫定结合胸腺肽抗病毒治疗,观察两组HBV-DNA清除率、HBeAg转阴率、复发时间和生存时间。结果治疗组和对照组比较,1、2年HBV-DNA清除率分别为98%比0%和100%比4%(P=0.0000,0.0000),HBeAg转阴率分别为60.0%比6.0%和73.5%比7.5%(P=0.002),中位复发时间分别为10.0个月比6.5个月(P=0.0032),中位生存时间分别为12.5个月比6.0个月(P=0.0021)。结论拉米夫定结合胸腺肽抗病毒治疗有助于合并活动性肝炎肝癌术后清除病毒复制,延迟复发,提高生存时间。     

拉米夫定对HBV—DNA阳性恶性肿瘤患者化疗所致HBV再激活的预防作用评价

目的：探讨拉米夫定对HBV—DNA阳性恶性肿瘤患者化疗所致HBV再激活的预防作用。方法：选择HBV—DNA阳性恶性肿瘤患者60例,分成两组,即试验组与对照组各30例。试验组在化疗前2周给予拉米夫定（100mg口服,qd,直至化疗结束后8周）。预防性治疗,观察化疗前后HBV—DNA水平变化情况,并与对照组比较。结果：试验组化疗后出现肝功能损害12例（40％）,HBV—DNA均〈10^4copies／ml,仅有1例HBV再激活。对照组肝功能损害23例（76．7％）,HBV—DNA〉10^4copies／ml22例（73．3％）,〉10^9copies／ml8例（26．7％）,其中有7例（23．3％）HBV再激活。试验组HBV再激活率明显低于对照组（3．3％VS23．3％,P〈0．05）,且肝功能损害率亦较低（40％VS76．7％,P〈0．05）。结论：拉米夫定可以有效预防和治疗HBV再激活,对防治HBV—DNA阳性的恶性肿瘤患者化疗所致肝损害有较好的效果。     

Hepatitis B virus reactivation and role of antiviral prophylaxis in lymphoma patients with past hepatitis B virus infection who are receiving chemoimmunotherapy

BACKGROUND:

Individuals who had past hepatitis B virus (HBV) infection appeared to clear their serum hepatitis B surface antigen (HBsAg) while producing antibody to the hepatitis B core antigen (HBcAb), which is detectable in their serum. Currently, it is uncertain whether patients with past HBV infection require routine antiviral prophylaxis during chemotherapy, although some cancer agencies recommend its routine use. The objective of the current study was to determine the prevalence of past HBV infection in patients with lymphoma and its relevance in terms of HBV‐related complications.

METHODS:

The authors reviewed 430 patients with lymphoma from May 2006 to May 2008.

RESULTS:

Among the 430 patients, 233 had both the HBsAg and HBcAb tests performed, whereas 197 had only the HBsAg test performed. Among those with both tests performed, 34.3% (80 of 233) were HBcAb positive only. Of these 80 patients, 58 had a concomitant HBV DNA level test, which was positive in 3 (5.2%). Of the 67 patients with past and 26 with chronic HBV infection who received chemotherapy, HBV reactivation occurred in 1.5% and 42.3% of patients, respectively (P<.0001). Prophylactic lamivudine was administered in 7 (10.4%) patients with past HBV infection and in 18 (69.2%) with chronic HBV infection.

CONCLUSIONS:

The low rate of HBV reactivation reported in our study coupled with the high prevalence of past HBV infection in an endemic area suggests that routine usage of antiviral prophylaxis may not be required for all patients with past HBV infection. Close surveillance remains a reasonable and viable option for the majority of patients. Cancer 2010. © 2010 American Cancer Society.     

Frequency of Hepatitis B Markers in Systemic Lupus Erythematosus Patients in Iran

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Hepatitis B virus is the causative agent for chronic, acute, cirrhosis, and hepatocellular carcinoma.  SLE patients with chronic or occult hepatitis B infection undergoing immunosuppressive drugs may become reactive and develop fatal hepatitis. Therefore, this study was conducted to determine HBV markers in SLE patients before the administration of immunosuppressive drugs in Ahvaz city, Iran. Materials and methods: The sera of 92 SLE patients were  tested for HBs Ag and anti-HBc using ELISA, HBV DNA (by Nested PCR) testes. Real-time PCR was performed for the patients with positive anti-HBc and negative HBsAg. The positive HBV DNA samples were checked for HBV genotype and HBV subtypes. Results: Among the 92 SLE patients, three (3.3%) were males and 89 (96.7%) females . The patients’ ages ranged from 14 to 70 years [mean age of 38.9±10.1]. Three of 92 (3.26%) subjects [2/3 males and 1/89 female] were positive for HBsAg, anti-HBc Ab, and HBV DNA detected with PCR (p=0.000003)].  Five of 89 (5.61%) subjects [1 male and 4/88 females were only positive for anti-HBc and negative for HBs Ag, HBV DNA(PCR) using Real-time PCR (p=0.05).  The results of the nucleotide data and phylogenetic tree showed all three HBV patients were genotype D1. The results of amino acid sequencing revealed all three HBV patients were HBV subtype ayw2. Conclusion: This study proved that 3.26% of SLE patients were positive for overt HBV infection (positive for anti-HBc, HBsAg and HBV-DNA using PCR). All the three isolated HBV were genotype D1 and subtype ayw2. The fact that 5.61% of  the patients were only positive for anti-HBc characterized the occult hepatitis B infection (OBI) although further investigation is needed. To prevent HBV or OBI reactivation for SLE patients before immunosuppression treatment, HBV markers including anti-HBc, HBsAg, HBV-DNA should be implemented using PCR and Real-time PCR .