Evaluating the risk of hepatitis B reactivation in patients with haematological malignancies: is the serum hepatitis B virus profile reliable?

• Published in: Liver international Vol. 29; no. 8; pp. 1171 - 1177
• Main Authors: Ferraro, Donatella, Pizzillo, Paola, Di Marco, Vito, Vultaggio, Anna, Iannitto, Emilio, Venezia, Giovanna, Craxì, Antonio, Di Stefano, Rosa
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2009
• Subjects: Antineoplastic Agents - therapeutic use; Cohort Studies; Comorbidity; DNA, Viral - blood; Female; HBsAg seroreversion; Hematologic Neoplasms - blood; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - virology; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B virus - isolation & purification; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - epidemiology; Hepatitis B, Chronic - virology; Hepatitis C virus; Humans; immunosuppression; Italy - epidemiology; Male; Middle Aged; nested PCR; OBI; Polymerase Chain Reaction - methods; Predictive Value of Tests; Recurrence; Retrospective Studies; Risk Factors; Virus Activation; Italy
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2009.02071.x

Background/Aim: Patients with an occult hepatitis B virus (HBV) infection undergoing deep immunosuppression are potentially at risk of HBV reactivation. In order to assess whether a polymerase chain reaction (PCR) assay for HBV DNA in serum could be used to predict the reactivation of an occult HBV infection, we performed a retrospective study in a cohort of Sicilian patients with oncohaematological diseases.
Methods: We studied by a highly sensitive ad hoc nested PCR for serum HBV DNA 75 HBsAg‐negative oncohaematological patients requiring chemotherapy.
Results: Thirty‐three patients (44%) were HBV seronegative (anti‐HBc and anti‐HBs negative) and 42 patients (56%) were HBV seropositive (anti‐HBc and/or anti‐HBs positive). Baseline serum HBV DNA was positive in nine out of 33 HBV‐seronegative patients and in nine out of 42 HBV‐seropositive patients (27.3 vs. 21.4%; P=NS). HBsAg seroconversion was observed in five out of 33 seronegative vs. six out of 42 seropositive patients (15 vs. 14%, P=0.9), and in five out of 18 HBV DNA‐positive vs. six out of 57 HBV DNA‐negative patients (27.7 vs. 10.6%P=0.11). Hepatitis C virus infection was found in 18 patients (24.3%), although with no correlation to HBV serological status, presence of serum HBV DNA or frequency of HBsAg seroconversion.
Conclusions: In oncohaematological patients undergoing chemotherapy, highly sensitive serum HBV DNA testing at baseline has a 28% predictive ability to forecast HBsAg seroconversion in HBV DNA‐positive patients, and a 90% ability to forecast persistent HBsAg negativity in HBV DNA‐negative patients, a better performance than serological tests.