Reactivation of Hepatitis B Virus (HBV) Following Cancer Chemotherapy

Abstract

Reactivation of Hepatitis B virus (HBV) may occur after immunosuppressive therapy and cancer
chemotherapy. Some of these cases may develop liver failure in a previously compensated disease. Aim of this
case report is to make an awareness of this reactivation of HBV in Bangladeshi society after cancer
chemotherapy or immunosuppressive therapy. A forty-five-year old lady, mother of one child was found to
have positive Hepatitis B surface antigen (HBsAg) since 1994 when the test was done for vaccination. She was
asymptomatic and clinically unremarkable. She was treated with standard Interferon for 24 weeks in 2000
when Alanine aminotransferase (ALT) was high, Hepatitis B envelope antigen (HBeAg) & HBV
deoxyribonucleic acid (DNA) were positive. After treatment HBeAg & HBV DNA were negative and ALT was
normal. She developed carcinoma of the left breast which was operated in July 2008. Combination cancer
chemotherapy 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 had
no symptoms. HBV DNA and ALT became normal. Reactivation of HBV may occur after cancer
chemotherapy or immunosuppressive therapy. At present recommendation of Asian Pacific Association for
Study of Liver (APASL), European Association for the Study of Liver (EASL) and American Association for
the Study of Liver Diseases (AASLD) is to start prophylactic Lamivudine, Entecavir or any other antiviral
drugs in all patients who are positive for HBsAg irrespective of HBeAg, ALT or HBV DNA status before
starting chemotherapy or immunosuppressive therapy. So, HBsAg and Anti HBc (Hepatitis B core) should be
tested in all such cases.

Key words: Hepatitis B virus reactivation; chemotherapy.

DOI: 10.3329/jafmc.v6i1.5991

Journal of Armed Forces Medical College, Bangladesh Vol.6(1) 2010 p.34-35