title: Prevalence and chemotherapy-induced reactivation of occult hepatitis B virus among hepatitis B surface antigen negative patients with diffuse large B-cell lymphoma: significance of hepatitis B core antibodies screening.
abstract: BACKGROUND
  Occult hepatitis B infection (OBI) is characterized by negative hepatitis B surface antigen (HBsAg) and detectable hepatitis B virus (HBV)-DNA in the liver and/or serum, with or without hepatitis B core antibody (anti-HBc). Anti-HBc is the most sensitive marker of previous HBV. HBV reactivation in patients under immunosuppressive treatment is life-threatening, occurring in both overt and occult HBV especially in hematological malignancies.
  
  
  OBJECTIVE
  To evaluate the prevalence and chemotherapy-induced reactivation of OBI among hepatitis B surface antigen negative patients with diffuse large B-cell lymphoma (DLBCL) patients and to determine the significance of anti-HBc screening among this group of patients before receiving chemotherapy.
  
  
  METHODS
  This cross-sectional study included 72 DLBCL patients negative for HBsAg, HBsAb and hepatitis C virus antibodies (anti-HCV). Patients were subjected to investigations including anti-HBc. All patients underwent alanine transaminase (ALT) monitoring before each cycle of chemotherapy and monthly for 12 months after the end of chemotherapy. Patients with suspected OBI were tested for HBV-DNA using real-time polymerase chain reaction (PCR).
  
  
  RESULTS
  Anti-HBc was detected in 10 of 72 HBsAg negative sera (13.89%) (95% confidence interval 6.9-22.2%). Five of the 10 anti-HBc positive patients in this study had OBI reactivation.
  
  
  CONCLUSIONS
  The study concluded that anti-HBc screening is mandatory before chemotherapy. HBsAg-negative/anti-HBc-positive patients should be closely observed for signs of HBV reactivation through the regular monitoring of ALT. Prophylaxis lamivudine is recommended for anti-HBc positive patients before chemotherapy.
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt. Electronic address: tamerelbedewy2006@yahoo.com.
authors.forename: Tamer A
authors.initials: TA
authors.lastname: Elbedewy
authors.affiliation: Medical Oncology Department, Tanta Cancer Center, Egypt.
authors.forename: Hossam Eldin A
authors.initials: HE
authors.lastname: Elashtokhy
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Tanta University, Egypt.
authors.forename: Enaam S
authors.initials: ES
authors.lastname: Rabee
authors.affiliation: Clinical Pathology Department, Tanta Cancer Center, Egypt.
authors.forename: Gamal E
authors.initials: GE
authors.lastname: Kheder
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006509:Hepatitis B / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D016867:Immunocompromised Host; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D014775:Virus Activation / Q000187:drug effects; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D006514:Hepatitis B Surface Antigens; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Anti-HBc; Diffuse large B-cell lymphoma; HBV-DNA; HBsAg; Hepatitis B virus; Occult HBV reactivation