Chemotherapy-related reactivation of hepatitis B infection: Updates in 2013

Table 1 Risk factors for anticancer chemotherapy-related hepatitis B virus reactivation

Categories	Risk factors	Ref.
Host factors	Male gender Young age Elevated baseline ALT	[8] [8] [63]
Tumor- or treatment-related factors	Lymphoma Hematologic malignancies Brease cancer Glucocorticoid use Anthracycline use Rituximab-based regimen Hematopoietic stem cell transplantation	[6,8] [8,64] [6] [6,16] [6] [17,29] [65]
Viral factors	High pre-chemotherapy viral load Positive HBeAg Presence of precore mutant Negative or low titer of HBsAb (in case of occult/past infection)	[66] [8,67] [25,68] [17]

ALT: Alanine aminotransferase; HBeAg: Hepatitis B e antigen; HBsAb: Hepatitis B surface antibody.

Table 2 Comparison of prophylactic strategies against the reactivation of hepatitis B with recent major guidelines

	AASLD (2009)[1]	EASL (2012)[40]	APASL (2012)[43]
Screening tests	HBsAg, anti-HBc	HBsAg, anti-HBc	HBsAg; anti-HBc in rituximab- or anti-TNF-α-treated patients
Duration of therapy	6 mo after the completion of chemotherapy/immunosuppression, if baseline HBV DNA < 2000 IU/mL; continue treatment until treatment endpoints in immune competent patients if HBV DNA > 2000 IU/mL	12 mo after cessation of chemotherapy	At least 24 wk after the end of chemotherapy
Antiviral agent	Lamivudine or telbivudine if duration of treatment ≤ 12 mo and baseline HBV DNA is undetectable; tenofovir or entecavir if longer treatment duration is needed	Lamivudine if low HBV DNA (< 2000 IU/mL) and a finite, short duration of immunosuppression is planned; entecavir or tenofovir if high HBV DNA and/or lengthy, repeated cycles of immunosuppression are planned	Lamivudine; entecavir or tenofovir can be used
Occult/past infection	Monitor HBV DNA; treat if HBV DNA becomes detectable	Test for HBV DNA; if HBV DNA-positive, treat similarly to HBsAg-positive patients; if HBV DNA-negative, follow every 1-3 mo with ALT and HBV DNA and treat upon reactivation before ALT elevation; preemptive therapy can be given if monitoring is not guaranteed or in cases of stem cell transplantation	Monitor HBV DNA; treat when needed

AASLD: American Association for the Study of Liver Diseases; EASL: European Association for the Study of the Liver; APASL: Asian Pacific Association for the Study of the Liver; HBsAg: Hepatitis B surface antigen; anti-HBc: Anti-hepatitis B core antibody; TNF: Tumor necrosis factor; HBV: Hepatitis B virus; ALT: Alanine aminotransferase.