Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Mar 25, 2024; 13(1): 89104
Published online Mar 25, 2024. doi: 10.5501/wjv.v13.i1.89104
Chronic hepatitis B and occult infection in chemotherapy patients - evaluation in oncology and hemato-oncology settings: The CHOICE study
Nayana Sudevan, Manish Manrai, T V S V G K Tilak, Harshit Khurana, Harikrishnan Premdeep
Nayana Sudevan, Harikrishnan Premdeep, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
Manish Manrai, Department of Gastroenterology, Command Hospital Cantonment Rd, Sadar Bazaar, Cantonment, Lucknow, Uttar Pradesh, India 226002
T V S V G K Tilak, Department of Internal Medicine, Command Hospital, Bangalore 560007, India
Harshit Khurana, Department of Geriatric Medicine, Armed Forces Medical College, Pune 411040, India
Author contributions: Manrai M conceptualized and supervised the study and was involved with obtaining resources, data collection, editing, and validation; Sudevan N conducted the study and was involved in writing the manuscript; Tilak TVSVGK and Khurana H were involved with obtaining resources and data curation, Premdeep H was involved with data curation and editing.
Institutional review board statement: The study protocol was reviewed and approved by the relevant ethical committee of Armed Forces Medical College, Pune, Maharashtra, India. Informed consent was obtained from all participants before their inclusion in the study. Confidentiality and privacy of patient information were strictly maintained throughout the study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Informed consent was obtained from all participants before their inclusion in the study. Confidentiality and privacy of patient information were strictly maintained throughout the study.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manish Manrai, FRCPE, MBBS, MD, Professor, Department of Gastroenterology, Command Hospital Cantonment Rd, Sadar Bazaar, Cantonment, 226002 Lucknow, Uttar Pradesh, India. manishmanrai75@yahoo.com
Received: October 20, 2023
Peer-review started: October 20, 2023
First decision: November 21, 2023
Revised: December 27, 2023
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: March 25, 2024
ARTICLE HIGHLIGHTS
Research background

The issue of reactivation of hepatitis B virus (HBV) infection is often missed due to inadequate evaluation, especially for occult HBV infection (OBI). This reactivation following immunosuppression can lead to liver dysfunction, which in turn either impacts the continuation of therapy and/or increases the morbidity and mortality in an already immunocompromised patient. We attempted to study the same to know the current status of evaluation protocols and the prevalence of HBV infection as well as reactivation.

Research motivation

The protocols for the evaluation of patients with malignancy need to include checking for OBI as it carries risk of reactivation following chemotherapy during treatment. The presence of pre-existing HBV infection always involves a gastroenterology or hepatology consult regarding the consideration of antiviral therapy. On the other hand, OBI is not considered routinely in pretreatment evaluation and therefore any possible prophylaxis is delayed. More data are required in these specific situations to formulate better protocols for the future.

Research objectives

Our primary objective was to determine the prevalence of chronic HBV (CHB) and OBI among oncology and hematology-oncology patients undergoing chemotherapy. We followed up with patients for reactivation and initiated treatment/prophylaxis as and when indicated.

Research methods

In this observational study, the prevalence of CHB and OBI was assessed among patients receiving chemotherapy. Serological markers of HBV infection [hepatitis B surface antigen (HBsAg)/anti-hepatitis B core antigen (HBc)/anti-hepatitis B surface antibody] were evaluated for all participants. Those who tested negative for HBsAg but positive for total anti-HBc were tested for HBV DNA levels. Due ethical clearance was taken and data of 400 patients were collected over 2 years. Appropriate statistics were applied for analysis in this observational study.

Research results

In our study, the prevalence of CHB within the study cohort was determined to be 2.3% [95% confidence interval (95%CI): 1.0-4.2]. Additionally, the prevalence of OBI among the study participants was found to be 0.8% (95%CI: 0.2-2.3). Although the prevalence seems low, on consideration of the people affected by malignancy worldwide, the numbers may be significant.

Research conclusions

The findings of this study highlight the importance of screening for hepatitis B infection in oncology and hematology-oncology patients undergoing chemotherapy. Identifying individuals with CHB and OBI is crucial for implementing appropriate antiviral prophylaxis to prevent the reactivation of HBV infection, which can lead to increased morbidity and mortality.

Research perspectives

The direction of future research should be to actively look for OBI.