Hong Kong Med J 2011;17:376–80 | Number 5, October 2011
Prospective evaluation of seropositive occult hepatitis B viral infection in lymphoma patients receiving chemotherapy
WI Cheung, SY Lin, Vincent KS Leung, Kitty SC Fung, YK Lam, FH Lo, TN Chau
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
OBJECTIVE. To serially evaluate the viral kinetics of occult hepatitis B virus infection in lymphoma patients and perform a correlation with clinical outcomes.
DESIGN. Case series with 1-year follow-up.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Consecutive patients who were newly diagnosed to have lymphoma in the hospital between 1 April 2007 and 31 March 2008 were tested for hepatitis B (HB) surface (s) antigen (Ag), anti-HBs antibody (Ab) and anti-HB core (c) Ab. Seropositive occult hepatitis B patients as defined by being negative for HBsAg but positive anti-HBsAb and/or anti-HBcAb without a hepatitis B vaccination history were recruited. Serum HBsAg, anti-HBsAb, anti-HBcAb, hepatitis B virus deoxyribonucleic acid (DNA) level, and liver biochemistry were checked at baseline and every 4 weeks during and after chemotherapy until 12 months after the completion of chemotherapy or death. Entecavir was started if patients developed biochemical flare_up of hepatitis B associated with virological rebound. The prevalence and course of hepatitis B virus–related hepatitis, as well as any temporal relationship to viral kinetics and clinical hepatitis, were assessed.
RESULTS. Of 47 patients tested, 10 (21%) with lymphoma were seropositive occult hepatitis carriers. Their median baseline hepatitis B virus DNA level was 89 IU/mL (range,
CONCLUSION. Detectable baseline serum hepatitis B virus DNA is not uncommon in patients with occult hepatitis B who receive chemotherapy. Transient elevation in serum hepatitis B virus DNA levels does not predict biochemical reactivation, but antiviral treatment might be considered if virological rebound persists.
Key words: Chemotherapy, adjuvant; DNA, viral; Hepatitis B virus; Lymphoma, non- Hodgkin; T-lymphocytes, cytotoxic
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