Download PDF
Semin Liver Dis 2007; 27: 018-024
DOI: 10.1055/s-2007-984696
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Treating Chronic Hepatitis B Infection in Patients Who Are Pregnant or Are Undergoing Immunosuppressive Chemotherapy

Norah A. Terrault1 , Ira M. Jacobson2
  • 1Division of Gastroenterology, University of California, San Francisco, San Francisco, California
  • 2Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York
Further Information

Publication History

Publication Date:
14 August 2007 (online)

    Permissions and Reprints

ABSTRACT

As our understanding of the natural history of hepatitis B virus (HBV) infection increases, so do the patient circumstances for which anti-HBV therapy is considered. For example, patients with chronic HBV infection that is negative for hepatitis B surface antigen can experience hepatitis flares during or after cytotoxic chemotherapy and thus are potential candidates for anti-HBV therapy. Also, although passive-active immunoprophylaxis is highly effective in preventing the vertical transmission of HBV, high maternal serum HBV DNA concentrations have been associated with the failure of immunoprophylaxis; for this reason, clinicians may consider administering anti-HBV therapy during pregnancy. However, prophylactic anti-HBV therapy can be both complex and controversial. A satellite symposium conducted during the 57th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) in Boston, Massachusetts, presented approaches to treating HBV infection in patients who are pregnant and in those who are preparing to receive chemotherapy.

KEYWORDS

Hepatitis B - nucleoside inhibitors - pregnancy - vertical transmission - immunosuppressive therapy - chemotherapy

REFERENCES

  • 1 Keeffe E B, Dieterich D T, Han S H et al.. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update.  Clin Gastroenterol Hepatol. 2006;  4 936-962
    CrossrefPubMedGoogle Scholar
  • 2 Lok A S, McMahon B J. Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD) . Chronic hepatitis B.  Hepatology. 2007;  45 507-539
    CrossrefPubMedGoogle Scholar
  • 3 Kohrt H E, Ouyang D L, Keeffe E B. Systematic review: lamivudine prophylaxis for chemotherapy-induced reactivation of chronic hepatitis B virus infection.  Aliment Pharmacol Ther. 2006;  24 1003-1016
    CrossrefPubMedGoogle Scholar
  • 4 Hui C K, Cheung W W, Zhang H Y et al.. Kinetics and risk of de novo hepatitis B infection in HBsAg-negative patients undergoing cytotoxic chemotherapy.  Gastroenterology. 2006;  131 59-68
    CrossrefPubMedGoogle Scholar
  • 5 Mast E E, Margolis H S, Fiore A E et al.. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1-immunization of infants, children, and adolescents.  MMWR Recomm Rep. 2005;  54 1-31
    PubMedGoogle Scholar
  • 6 Dore G J, Guan R, Wasim Jafri S M et al.. Management of chronic hepatitis B in challenging patient populations.  Liver Int. 2006;  26(suppl 2) 38-46
    CrossrefPubMedGoogle Scholar
  • 7 Zhang S L, Yue Y F, Bai G Q et al.. Mechanism of intrauterine infection of hepatitis B virus.  World J Gastroenterol. 2004;  10 437-438
    PubMedGoogle Scholar
  • 8 del Canho R, Grosheide P M, Mazel J A et al.. Ten-year neonatal hepatitis B vaccination program, The Netherlands, 1982-1992: protective efficacy and long-term immunogenicity.  Vaccine. 1997;  15 1624-1630
    CrossrefPubMedGoogle Scholar
  • 9 Ngui S L, Andrews N J, Underhill G S et al.. Failed postnatal immunoprophylaxis for hepatitis B: characteristics of maternal hepatitis B virus as risk factors.  Clin Infect Dis. 1998;  27 100-106
    PubMedGoogle Scholar
  • 10 van Zonneveld M, van Nunen A B, Niesters H G et al.. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection.  J Viral Hepat. 2003;  10 294-297
    CrossrefPubMedGoogle Scholar
  • 11 Yeo W, Zee B, Zhong S et al.. Comprehensive analysis of risk factors associating with hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy.  Br J Cancer. 2004;  90 1306-1311
    CrossrefPubMedGoogle Scholar
  • 12 Yeo W, Chan P K, Zhong S et al.. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors.  J Med Virol. 2000;  62 299-307
    CrossrefPubMedGoogle Scholar
  • 13 Hui C K, Cheung W W, Au W Y et al.. Hepatitis B reactivation after withdrawal of pre-emptive lamivudine in patients with haematological malignancy on completion of cytotoxic chemotherapy.  Gut. 2005;  54 1597-1603
    CrossrefPubMedGoogle Scholar
  • 14 Li Y H, He Y F, Jiang W Q et al.. Lamivudine prophylaxis reduces the incidence and severity of hepatitis in hepatitis B virus carriers who receive chemotherapy for lymphoma.  Cancer. 2006;  106 1320-1325
    CrossrefPubMedGoogle Scholar
  • 15 Dai M S, Wu P F, Shyu R Y et al.. Hepatitis B virus reactivation in breast cancer patients undergoing cytotoxic chemotherapy and the role of preemptive lamivudine administration.  Liver Int. 2004;  24 540-546
    CrossrefPubMedGoogle Scholar
  • 16 Idilman R, Arat M, Soydan E et al.. Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies.  J Viral Hepat. 2004;  11 141-147
    PubMedGoogle Scholar
  • 17 Yeo W, Ho W M, Hui P et al.. Use of lamivudine to prevent hepatitis B virus reactivation during chemotherapy in breast cancer patients.  Breast Cancer Res Treat. 2004;  88 209-215
    CrossrefPubMedGoogle Scholar
  • 18 Yeo W, Hui E P, Chan A T et al.. Prevention of hepatitis B virus reactivation in patients with nasopharyngeal carcinoma with lamivudine.  Am J Clin Oncol. 2005;  28 379-384
    CrossrefPubMedGoogle Scholar
  • 19 Lau G K, Yiu H H, Fong D Y et al.. Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy.  Gastroenterology. 2003;  125 1742-1749
    CrossrefPubMedGoogle Scholar
  • 20 Lee G W, Ryu M H, Lee J L et al.. The prophylactic use of lamivudine can maintain dose-intensity of adriamycin in hepatitis-B surface antigen (HBs Ag)-positive patients with non-Hodgkin’s lymphoma who receive cytotoxic chemotherapy.  J Korean Med Sci. 2003;  18 849-854
    PubMedGoogle Scholar
  • 21 Sera T, Hiasa Y, Michitaka K et al.. Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab.  Intern Med. 2006;  45 721-724
    CrossrefPubMedGoogle Scholar
  • 22 Xu W-M, Cui Y-T, Wang L et al.. Efficacy and safety of lamivudine in late pregnancy for the prevention of mother-child transmission of hepatitis B: a multicentre, randomised, double-blind, placebo-controlled study.  Hepatology. 2004;  40(suppl 4) 272A Abstract 246
    PubMedGoogle Scholar
  • 23 Idenix Pharmaceuticals .TYZEKA™ (telbivudine) tablets prescribing information. Available at: https://www.tyzeka.com/default.asp?page=prescribing_information Accessed December 20, 2006
    Google Scholar
  • 24 Ross B. Safety of antiviral therapy of chronic hepatitis B during pregnancy. Presented at: National Institutes of Health Hepatitis B Workshop April 6-8, 2006 Bethesda, MD;
    Google Scholar
  • 25 Kuo A, Dienstag J L, Chung R T. Tenofovir disoproxil fumarate for the treatment of lamivudine-resistant hepatitis B.  Clin Gastroenterol Hepatol. 2004;  2 266-272
    CrossrefPubMedGoogle Scholar
  • 26 van Bommel F, Wunsche T, Mauss S et al.. Comparison of adefovir and tenofovir in the treatment of lamivudine-resistant hepatitis B virus infection.  Hepatology. 2004;  40 1421-1425
    CrossrefPubMedGoogle Scholar
  • 27 The Antiretroviral Pregnancy Registry Steering Committee .Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 January 2006. Wilmington, NC; Registry Coordinating Center 2006 Available at: http://www.apregistry.com/forms/apr_report_106.pdf Accessed December 20, 2006
    Google Scholar
  • 28 Centers for Disease Control and Prevention (CDC) . Improved national prevalence estimates for 18 selected major birth defects-United States, 1999-2001.  MMWR Morb Mortal Wkly Rep. 2006;  54 1301-1305
    PubMedGoogle Scholar
  • 29 Millonig G, Kern M, Ludwiczek O et al.. Subfulminant hepatitis B after infliximab in Crohn’s disease: need for HBV-screening?.  World J Gastroenterol. 2006;  12 974-976
    PubMedGoogle Scholar

Norah A TerraultM.D. M.P.H. 

Division of Gastroenterology, University of California, San Francisco

513 Parnassus Avenue, S357, San Francisco, CA 94143-0538

      >