Reactivation of Hepatitis B Virus (HBV) Following Cancer Chemotherapy

摘要

Reactivation of Hepatitis B virus (HBV) may occur after immunosuppressive therapy and cancerchemotherapy. Some of these cases may develop liver failure in a previously compensated disease. Aim of thiscase report is to make an awareness of this reactivation of HBV in Bangladeshi society after cancerchemotherapy or immunosuppressive therapy. A forty-five-year old lady, mother of one child was found tohave positive Hepatitis B surface antigen (HBsAg) since 1994 when the test was done for vaccination. She wasasymptomatic and clinically unremarkable. She was treated with standard Interferon for 24 weeks in 2000when Alanine aminotransferase (ALT) was high, Hepatitis B envelope antigen (HBeAg) & HBVdeoxyribonucleic acid (DNA) were positive. After treatment HBeAg & HBV DNA were negative and ALT wasnormal. She developed carcinoma of the left breast which was operated in July 2008. Combination cancerchemotherapy started. After 5th cycle of chemotherapy she developed rise of ALT (1200 i.u/L) and HBV DNA(> 105 copies/ml). Patient was treated with tablet Lamivudine 100 mg/day. After one year of follow up she hadno symptoms. HBV DNA and ALT became normal. Reactivation of HBV may occur after cancerchemotherapy or immunosuppressive therapy. At present recommendation of Asian Pacific Association forStudy of Liver (APASL), European Association for the Study of Liver (EASL) and American Association forthe Study of Liver Diseases (AASLD) is to start prophylactic Lamivudine, Entecavir or any other antiviraldrugs in all patients who are positive for HBsAg irrespective of HBeAg, ALT or HBV DNA status beforestarting chemotherapy or immunosuppressive therapy. So, HBsAg and Anti HBc (Hepatitis B core) should betested in all such cases.