title: Hepatitis B virus management to prevent reactivation after chemotherapy: a review.
abstract: OBJECTIVE
  Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy.
  
  
  METHODS
  We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library.
  
  
  RESULTS
  Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests-HBsAg, anti-HBc, and anti-HBs-allows the most thorough interpretation of a patient's serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies.
  
  
  CONCLUSIONS
  Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jphwang@mdanderson.org
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Hwang
authors.forename: John M
authors.initials: JM
authors.lastname: Vierling
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Susan C
authors.initials: SC
authors.lastname: Lackey
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage*; D006509:Hepatitis B / Q000209:etiology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy; D012307:Risk Factors; D014775:Virus Activation
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens