Volume 13 Supplement 1

Proceedings of the 9th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof Dr Matei Bals”

Open Access

HDV+HBV hepatitis reactivation due to immunossuppressive therapy for hematological malignancies – an increasingly complex challenge

  • Violeta Molagic1Email author,
  • Raluca Mihăilescu1,
  • Cristina Popescu1, 2,
  • Cătălin Tilişcan1, 2,
  • Mihaela Rădulescu1, 2,
  • Raluca Năstase1,
  • Ruxandra Moroti1, 2,
  • Viorica Poghirc1 and
  • Victoria Aramă1, 2
BMC Infectious Diseases201313(Suppl 1):O24

https://doi.org/10.1186/1471-2334-13-S1-O24

Published: 16 December 2013

Background

Hepatitis B virus reactivation (HBV-R) is becoming an increasingly concerning issue as monoclonal antibody therapy has become widely used for chronic lymphoproliferations. HBV-R can also occur in HBsAg negative patients who have only HBcAb positive (occult HBV infection).

We present a non-consecutive HBV-R case series report. Our series consisted of both HBsAg positive patients and patients with occult HBV infection, who received monoclonal antibody therapy. We present the most important demographic, clinical and immune-virological features of HBV-R in these patients.

Case report

We also include the case of a 62 year old male patient with a previously HBs Ag negative, HBcAb positive status who was diagnosed with small B cell non Hodgkin lymphoma (NHL). The liver function tests were normal. The patient started cyclophosphamide-adriamycin-vincristine-prednisone+rituximab cycles and preemptive therapy with lamivudine 100 mg/day for HBV-R. After 5 cycles the patient developed asthenia and anorexia. He had increased serum aminotransferase (x10 ULN) levels and low platelet count. He tested negative for HAV, HCV, EBV, CMV markers and positive for HBV (positive HBsAg, HBcAb and HBeAb), with HBV-DNA of 79 UI/mL. The patient had HDV total antibodies and high viral load: HDV-RNA = 555,000,000 geq/mL. He was diagnosed with hepatitis HDV/HBV reactivation due to chemotherapy for B cell-NHL. Although NHL was in partial remission, the chemotherapy and lamivudine were stopped. He started pegIFN alpha-2a therapy when ALT values were almost within normal range.

Conclusion

The problem of HBV/HDV hepatitis reactivation in patients receiving immunosuppressive treatment is insufficiently known. Preemptive antiviral therapy prior to monoclonal antibody administration may be crucial for preventing HBV-R even in the presence of occult HBV infection. It is important to draw attention to the possibility of HDV reactivation, as an occult delta virus infection may be present even in persons with occult HBV infection.

Authors’ Affiliations

(1)
National Institute for Infectious Diseases “Prof. Dr. Matei Balş”
(2)
Carol Davila University of Medicine and Pharmacy

Copyright

© Molagic et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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