title: Managing hepatitis B virus carriers with systemic chemotherapy or biologic therapy in the outpatient clinic.
abstract: OBJECTIVE
  The number of outpatients receiving systemic chemotherapy in Japan has recently increased. We retrospectively examined whether hepatitis B virus (HBV) carriers were safely treated and managed with systemic chemotherapy or biologic agents as outpatients at our oncology center.
  
  
  METHODS
  A total of 40 115 consecutive infusion chemotherapy or biologic therapies were administrated to 2754 outpatients in the Chemotherapy and Oncology Center at Osaka University Hospital from December 2003 to March 2011. We first studied the prevalence of outpatients with hepatitis B surface antigen (HBsAg), and then retrospectively evaluated a database to determine the frequencies of testing for other HBV-related markers and the incidence of developing hepatitis or HBV reactivation in patients positive for HBsAg. As a control for comparison, we also examined these same factors in patients with hepatitis C virus antibody (anti-HCV).
  
  
  RESULTS
  The majority of physicians at our hospital screened for HBsAg (95%) and anti-HCV (94%) prior to administrating chemotherapy. Of the 2754 outpatients, 46 (1.7%) were positive for HBsAg and 90 (3.3%) were positive for anti-HCV. Fifteen patients that were HBsAg positive were treated with lamivudine or entecavir prior to chemotherapy. None of the patients with HBsAg taking a prophylactic antiviral developed hepatitis, and only one breast cancer patient without prophylactic antiviral treatment (1/31 [3.2%]) developed hepatitis due to HBV reactivation.
  
  
  CONCLUSIONS
  HBV reactivation occurred in outpatients without prophylactic antiviral treatment, but the incidence was relatively low.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine Chemotherapy and Oncology Center, Osaka University Hospital, Osaka, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.forename: Naoki
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authors.lastname: Hiramatsu
authors.forename: Masao
authors.initials: M
authors.lastname: Mizuki
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagatomo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kida
authors.forename: Keiko
authors.initials: K
authors.lastname: Tazumi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Shinzaki
authors.forename: Masanori
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yakushijin
authors.forename: Tomohide
authors.initials: T
authors.lastname: Tatsumi
authors.forename: Hideki
authors.initials: H
authors.lastname: Iijima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kiso
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kanto
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujii
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara