Reactivation of hepatitis B with reappearance of hepatitis B surface antigen after chemotherapy and immunosuppression.
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.
Palmore
Tara N
TN
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
Shah
Neeral L
NL
Loomba
Rohit
R
Borg
Brian B
BB
Lopatin
Uri
U
Feld
Jordan J
JJ
Khokhar
Farooq
F
Lutchman
Glen
G
Kleiner
David E
DE
Young
Neal S
NS
Childs
Richard
R
Barrett
A John
AJ
Liang
T Jake
TJ
Hoofnagle
Jay H
JH
Heller
Theo
T
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*
D019380:Anti-HIV Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents