title: An optimized antiviral modification strategy for prevention of hepatitis B reactivation in patients undergoing prophylactic lamivudine and chemotherapy: a pilot study.
abstract: In patients receiving prophylactic lamivudine (LAM) and chemotherapy, hepatitis B virus (HBV) reactivation cannot be eliminated without knowing the latent causes and optimal management. In our previous study, virus breakthrough and relapse were highly suspected as potential virologic causes for HBV reactivation. Therefore, we reviewed 24 previous studies and 447 patients who underwent chemotherapy and prophylactic LAM, with an incidence of 7.2 % HBV reactivation. Virus breakthrough and relapse were seldom investigated in these studies. In addition, 72 patients that underwent prophylactic LAM and chemotherapy at our centers were also analyzed. Among them, eight patients developed virus breakthrough, with another nine developing virus relapse after discontinuation of LAM. Eight patients received antiviral modification, which included administration of adefovir for patients with virus breakthrough or resumption of LAM for patients with virus relapse and none of them developed HBV reactivation. In contrast, of the nine patients who did not receive antiviral modification, six developed HBV reactivation and two died. In conclusion, this study demonstrated that virus breakthrough and relapse were the critical causative factors of HBV reactivation in patients receiving chemotherapy and prophylactic LAM. An optimized antiviral modification strategy could effectively prevent HBV reactivation in patients with virus breakthrough or relapse.
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China. wuxiangy@mail.sysu.edu.cn
authors.forename: Xiang-Yuan
authors.initials: XY
authors.lastname: Wu
authors.forename: Xing
authors.initials: X
authors.lastname: Li
authors.forename: Zhan-Hong
authors.initials: ZH
authors.lastname: Chen
authors.forename: Jing-Yun
authors.initials: JY
authors.lastname: Wen
authors.forename: Qu
authors.initials: Q
authors.lastname: Lin
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Xing
authors.forename: Min
authors.initials: M
authors.lastname: Dong
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Ze-Xiao
authors.initials: ZX
authors.lastname: Lin
authors.forename: Xiang-bo
authors.initials: XB
authors.lastname: Wan
authors.forename: Dan-Yun
authors.initials: DY
authors.lastname: Ruan
authors.forename: Xiao-Kun
authors.initials: XK
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D018963:Hepatitis Antigens / Q000378:metabolism; D006509:Hepatitis B / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D010865:Pilot Projects; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D018963:Hepatitis Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine