title: Persistent risk of HBV reactivation despite extensive lamivudine prophylaxis in haematopoietic stem cell transplant recipients who are anti-HBc-positive or HBV-negative recipients with an anti-HBc-positive donor.
abstract: The overall rate of hepatitis B virus (HBV) reactivation was evaluated in a population of 373 haematological stem cell transplant (HSCT) patients treated with lamivudine (LMV) if they were anti-HBc-positive/HBV-DNA-negative recipients or if they were HBV-negative recipients with an anti-HBc-positive donor. The incidence of HBV reactivation was calculated in two groups of autologous (auto) or allogeneic (allo) HSCT patients who were stratified according to their HBV serostatus. The former group included 57 cases: 10 auto-HSCT and 27 allo-HSCT anti-HBc-positive recipients, two auto-HSCT and three allo-HSCT inactive carriers, and 15 allo-HSCT recipients with an anti-HBc-positive donor. Forty-seven (82.4%) patients in this group received LMV prophylaxis (the median (interquartile range, IQR) of LMV treatment was 30 (20-38) months). The second group consisted of 320 anti-HBc-negative auto-HSCT and allo-HSCT recipients with anti-HBc-negative donors. None of these patients received any prophylaxis. Two patients in the first group and two in the second group experienced reactivation of HBV infection, with an incidence of 3.5% (95% CI 0.4-12.1%) and 0.6% (95% CI 0.1-2.2%), respectively. Only one out of four reactivated patients was LMV-treated. The cumulative probability of HBV reactivation at 6 years from HSCT was 15.8% (95% CI 15.2-16.4%). Three of four viral isolates obtained from the HBV-reactivated patients harboured mutations in the immune-active HBsAg-region. In a HSCT population carefully evaluated for HBV prophylaxis, a risk of HBV reactivation persisted in the group of patients who were not LMV-treated. Only one LMV-treated patient experienced reactivation of HBV with a resistant HBV isolate.
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cerva
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Colagrossi
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Maffongelli
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Salpini
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Di Carlo
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Malagnino
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Battisti
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ricciardi
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pollicita
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Picardi
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cudillo
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cerretti
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: De Angelis
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cantonetti
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Andreoni
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: C F
authors.initials: CF
authors.lastname: Perno
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Svicher
authors.affiliation: Clinical Infectious Disease, Department of System Medicine, Tor Vergata University, Rome, Italy. Electronic address: sarmati@med.uniroma2.it.
authors.forename: L
authors.initials: L
authors.lastname: Sarmati
mesh_terms: D000328:Adult; D002353:Carrier State / Q000276:immunology; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006509:Hepatitis B / Q000453:epidemiology*; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D014775:Virus Activation / Q000187:drug effects
chemical_list: D019259:Lamivudine
keywords: HBV infection; HBV reactivation; Haematological stem cell transplantation; Lamivudine; Prophylaxis