Systematic review: lamivudine prophylaxis for chemotherapy-induced reactivation of chronic hepatitis B virus infection.
BACKGROUND
Reactivation of hepatitis B virus infection in asymptomatic hepatitis B surface antigen carriers undergoing chemotherapy or immunosuppressive therapy is a well-documented and potentially fatal complication. Data supporting the use of lamivudine for primary prophylaxis have emerged, but its use remains controversial and is not standardized.


OBJECTIVE
To review current randomized-controlled trials, randomized trials and prospective case series to provide a clinically applicable, evidence-based recommendation.


METHODS
The published literature was identified using a MEDLINE/PubMed search with secondary review of cited publications, and inclusion of all prospective studies.


RESULTS
In nine prospective trials and one randomized-controlled trial, the rate of hepatitis among subjects receiving lamivudine prophylaxis ranged from 0% to 20% (16 of 173, 9.2%), compared with 33-67% among controls. Of patients receiving prophylaxis, 0-24% (15 of 173, 8.7%) developed hepatitis B virus reactivation, compared with 29-56% of controls. Three reactivation-related mortalities were reported (one receiving prophylaxis, two controls). No patients withdrew secondary to toxicity or development of lamivudine-resistant mutations.


CONCLUSIONS
The available data show a four- to sevenfold decrease in the rate of hepatitis and hepatitis B virus reactivation in patients who receive lamivudine prophylaxis. It is thus recommended that all hepatitis B surface antigen carriers receive lamivudine, or a comparable anti-viral agent, as prophylaxis from the initiation of chemotherapy until at least 1 year following its completion.
Kohrt
H E
HE
Division of Hematology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA.
Ouyang
D L
DL
Keeffe
E B
EB
D000970:Antineoplastic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use*; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine