title: Reactivation of hepatitis B with reappearance of hepatitis B surface antigen after chemotherapy and immunosuppression.
abstract: OBJECTIVE
  HBV infection may reactivate in the setting of immunosuppression, although the frequency and consequences of HBV reactivation are not well known. We report 6 patients who experienced loss of serologic markers of hepatitis B immunity and reappearance of HBsAg in the serum as a result of a variety of acquired immune deficiencies.
  
  
  METHODS
  Between 2000 and 2005, six patients with reactivation of hepatitis B were seen in consultation by the Liver Diseases Branch at the Clinical Center, National Institutes of Health. The course and outcome of these 6 patients were reviewed.
  
  
  RESULTS
  All 6 patients developed reappearance of HBsAg and evidence of active liver disease after stem cell transplantation (n = 4), immunosuppressive therapy (n = 1), or change in human immunodeficiency virus antiretroviral regimen (n = 1), despite having antibody to HBsAg (anti-HBs) or antibody to hepatitis B core antigen (anti-HBc) without HBsAg before. All 6 patients developed chronic hepatitis B, 2 patients transmitted hepatitis B to their spouses, and 1 patient developed cirrhosis. The diagnosis of hepatitis B reactivation was frequently missed or delayed and often required interruption of the therapy for the underlying condition. None of the patients received antiviral prophylaxis against HBV reactivation.
  
  
  CONCLUSIONS
  Serologic evidence of recovery from hepatitis B infection does not preclude its reactivation after immunosuppression. Screening for serologic evidence of hepatitis B and prophylaxis of those with positive results by using nucleoside analogue antiviral therapy should be provided to individuals in whom immunosuppressive therapy is planned.
authors: National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, MSC 1888, Bethesda, Maryland 20892-1888, USA. tpalmore@niaid.nih.gov
authors: Tara N
authors: TN
authors: Palmore
authors: Neeral L
authors: NL
authors: Shah
authors: Rohit
authors: R
authors: Loomba
authors: Brian B
authors: BB
authors: Borg
authors: Uri
authors: U
authors: Lopatin
authors: Jordan J
authors: JJ
authors: Feld
authors: Farooq
authors: F
authors: Khokhar
authors: Glen
authors: G
authors: Lutchman
authors: David E
authors: DE
authors: Kleiner
authors: Neal S
authors: NS
authors: Young
authors: Richard
authors: R
authors: Childs
authors: A John
authors: AJ
authors: Barrett
authors: T Jake
authors: TJ
authors: Liang
authors: Jay H
authors: JH
authors: Hoofnagle
authors: Theo
authors: T
authors: Heller
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications; D006509:Hepatitis B / Q000139:chemically induced*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents