title: HBV disease: HBsAg carrier and occult B infection reactivation in haematological setting.
abstract: HBV reactivation in patients with haematological malignancies undergoing chemoimmunotherapy is a serious and frequent complication. This is linked to either the high frequency of inactive HbsAg carriers and occult B infection among oncohaematological patients or the profound immunosuppression caused by high dose chemotherapy, monoclonal antibody therapy or auto- and allo-haematopoietic stem cell (HSC) transplantations. Identifying the patients at risk is mandatory in this clinical setting and prophylaxis with antiviral drugs or close monitoring may reduce and/or eliminate the HBV reactivation risk and the serious consequences. In general, preemptive anti-HBV therapy is more effective than treatment at reactivation. Prompt lamivudine prophylaxis should be given to HBsAg positive patients (inactive carriers) undergoing chemotherapy-immunochemotherapy and continued after cessation of immunosuppression even though long-term lamivudine therapy involves a risk of developing drug resistance. Use of newer anti-HBV agents may be considered. HBV reactivation has also been observed in occult B infection (HBcAb positive) and the optimal management of this group of patients requires special attention.
authors.affiliation: S.C. Medicina Interna 2 - Ospedale San Giovanni Battista - Molinette - C.so Bramante 88, 10100 Torino, Italy. carlo.marinone@tin.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Marinone
authors.forename: Monica
authors.initials: M
authors.lastname: Mestriner
mesh_terms: D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000494:pharmacology; D000998:Antiviral Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000821:virology*; D006509:Hepatitis B / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D007165:Immunosuppression Therapy; D007938:Leukemia / Q000188:drug therapy; D008223:Lymphoma / Q000188:drug therapy; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens