title: Treatment induced seroconversion to HBsAb following HBV reactivation in the immunosuppressed haematology and oncology patient: a clinical survey of 5 cases in Catania, Italy.
abstract: BACKGROUND
  In onco-haematological patients inactive or occult HBV infection may be reactivated as a result of disease-related immuno-suppression and/or chemotherapy with rituximab.
  
  
  OBJECTIVE
  This study reports the clinical features of five patients affected by onco-haematological disorders who experienced hepatitis B reactivation.
  
  
  METHODS
  From 2005 to 2010, five onco-haematological patients with hepatitis B reactivation were admitted to the department of Infectious Diseases, Ferrarotto Hospital, Catania, Italy.
  
  
  RESULTS
  At the time of onco-haematological disease diagnosis, 3 patients were HBcAb positive; 1 HBsAb and HBcAb positive; and 1 HBsAg positive, HBV DNA negative. None of the patients received hepatitis B prophylaxis. Reactivation was observed following chemotherapy. One patient was treated with lamivudine, 2 with tenofovir and 2 with telbivudine. Following treatment all patients achieved undetectable HBV DNA and normalization of transaminases. Three patients, those treated with lamivudine and tenofovir, cleared HBsAg and developed protective titres of HBsAb. The remaining patients, who were treated with telbivudine, were HBV DNA negative and HBsAg positive one at 27 months and the other at 5 months of therapy. Treatment thus continued in these patients.
  
  
  CONCLUSIONS
  HBV reactivation can be a severe complication in onco-haematological patients undergoing chemotherapy with rituximab. In our experience all nucleos(t)ide analogues were safe and effective. Three patients seroconverted to HBsAb. This may be as a result of the antivirals enhancing the immune response to HBV. A similar role may also be played by immune recovery following the withdrawal of immune-suppressive treatment. This report confirms the importance of anti-viral prophylaxis in patients with a high risk of HBV reactivation.
authors: Infectious Diseases Unit, AO Policlinico-V. Emanuele, Catania, Italy.
authors: Arturo
authors: A
authors: Montineri
authors: Luciano
authors: L
authors: Nigro
authors: Rosario
authors: R
authors: La Rosa
authors: Carmelo
authors: C
authors: Iacobello
authors: Licia
authors: L
authors: Larocca
authors: Elisa
authors: E
authors: Cappello
authors: Paolo Fabio
authors: PF
authors: Fiumara
authors: Francesco
authors: F
authors: Di Raimondo
authors: Filippo
authors: F
authors: Fatuzzo
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007558:Italy; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab