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Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma
BACKGROUND & AIMS: Despite increasing attention to hepatitis B virus (HBV) reactivation in hematologic settings, information on reactivation in hepatitis B surface (HBsAg)-negative patients with hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine the incidence and risk...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403914/ https://www.ncbi.nlm.nih.gov/pubmed/25894607 http://dx.doi.org/10.1371/journal.pone.0122041 |
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author | Jang, Jeong Won Kim, Young Woon Lee, Sung Won Kwon, Jung Hyun Nam, Soon Woo Bae, Si Hyun Choi, Jong Young Yoon, Seung Kew Chung, Kyu Won |
author_facet | Jang, Jeong Won Kim, Young Woon Lee, Sung Won Kwon, Jung Hyun Nam, Soon Woo Bae, Si Hyun Choi, Jong Young Yoon, Seung Kew Chung, Kyu Won |
author_sort | Jang, Jeong Won |
collection | PubMed |
description | BACKGROUND & AIMS: Despite increasing attention to hepatitis B virus (HBV) reactivation in hematologic settings, information on reactivation in hepatitis B surface (HBsAg)-negative patients with hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine the incidence and risk factors of HBV reactivation in HBsAg-negative patients undergoing transarterial chemoembolization (TACE). METHODS: A total of 109 HBsAg-negative patients with HCC were consecutively recruited for this study and treated with either mono- (n = 75), combination-drug TACE (n = 20), or combination-drug TACE plus radiotherapy (n = 14). With serial monitoring of virological markers every 2–3 months, patients were observed for HBV reactivation (defined as the reappearance of HBV DNA or sero-reversion of HBsAg) in comparison with control subjects with HBsAg-negative cirrhosis (n = 16) or HBsAg loss (n = 46). RESULTS: During the study period, HBV reactivation occurred in 12 (11.0%) and 1 (1.6%) patients in the TACE and control groups, respectively. The median level of HBV DNA at reactivation was 5,174 copies/ml (range: 216–116,058). Of the 12 patients with HBV reactivation, four (33.3%) developed clinical hepatitis, including one patient who suffered from decompensation. All antiviral-treated patients achieved undetectable HBV DNA or HBsAg loss after commencement of antiviral drugs. TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment. On multivariate analysis, treatment intensity and a prior history of chronic hepatitis B remained independently predictive of reactivation. CONCLUSIONS: TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation. Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation. |
format | Online Article Text |
id | pubmed-4403914 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44039142015-05-02 Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma Jang, Jeong Won Kim, Young Woon Lee, Sung Won Kwon, Jung Hyun Nam, Soon Woo Bae, Si Hyun Choi, Jong Young Yoon, Seung Kew Chung, Kyu Won PLoS One Research Article BACKGROUND & AIMS: Despite increasing attention to hepatitis B virus (HBV) reactivation in hematologic settings, information on reactivation in hepatitis B surface (HBsAg)-negative patients with hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine the incidence and risk factors of HBV reactivation in HBsAg-negative patients undergoing transarterial chemoembolization (TACE). METHODS: A total of 109 HBsAg-negative patients with HCC were consecutively recruited for this study and treated with either mono- (n = 75), combination-drug TACE (n = 20), or combination-drug TACE plus radiotherapy (n = 14). With serial monitoring of virological markers every 2–3 months, patients were observed for HBV reactivation (defined as the reappearance of HBV DNA or sero-reversion of HBsAg) in comparison with control subjects with HBsAg-negative cirrhosis (n = 16) or HBsAg loss (n = 46). RESULTS: During the study period, HBV reactivation occurred in 12 (11.0%) and 1 (1.6%) patients in the TACE and control groups, respectively. The median level of HBV DNA at reactivation was 5,174 copies/ml (range: 216–116,058). Of the 12 patients with HBV reactivation, four (33.3%) developed clinical hepatitis, including one patient who suffered from decompensation. All antiviral-treated patients achieved undetectable HBV DNA or HBsAg loss after commencement of antiviral drugs. TACE was significantly correlated with a high incidence of HBV reactivation, with increasing risk of reactivation with intensive treatment. On multivariate analysis, treatment intensity and a prior history of chronic hepatitis B remained independently predictive of reactivation. CONCLUSIONS: TACE can reactivate HBV replication in HBsAg-negative patients, with a dose-risk relationship between treatment intensity and reactivation. Patients with prior chronic HBV infection who are to undergo intensive TACE should be closely monitored, with an alternative approach of antiviral prophylaxis against HBV reactivation. Public Library of Science 2015-04-20 /pmc/articles/PMC4403914/ /pubmed/25894607 http://dx.doi.org/10.1371/journal.pone.0122041 Text en © 2015 Jang et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Jang, Jeong Won Kim, Young Woon Lee, Sung Won Kwon, Jung Hyun Nam, Soon Woo Bae, Si Hyun Choi, Jong Young Yoon, Seung Kew Chung, Kyu Won Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title | Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title_full | Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title_fullStr | Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title_full_unstemmed | Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title_short | Reactivation of Hepatitis B Virus in HBsAg-Negative Patients with Hepatocellular Carcinoma |
title_sort | reactivation of hepatitis b virus in hbsag-negative patients with hepatocellular carcinoma |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403914/ https://www.ncbi.nlm.nih.gov/pubmed/25894607 http://dx.doi.org/10.1371/journal.pone.0122041 |
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