Evaluating the risk of hepatitis B reactivation in patients with haematological malignancies: is the serum hepatitis B virus profile reliable?
OBJECTIVE
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.
Ferraro
Donatella
D
Cattedra di Virologia, Dipartimento di Scienze per la Promozione della Salute 'G. D'Alessandro', University of Palermo, Sicily, Italy. dferraro@unipa.it
Pizzillo
Paola
P
Di Marco
Vito
V
Vultaggio
Anna
A
Iannitto
Emilio
E
Venezia
Giovanna
G
Craxì
Antonio
A
Di Stefano
Rosa
R
D000970:Antineoplastic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014775:Virus Activation
D000970:Antineoplastic Agents; D004279:DNA, Viral