Association of Hepatitis B Core‐Related Antigen With Hepatitis B Virus Reactivation in Occult Viral Carriers Undergoing High‐Risk Immunosuppressive Therapy. (December 2016)

• Record Type: Journal Article
• Authors: Seto, Wai‐Kay; Wong, DannyKa‐Ho; Chan, ThomasSau‐Yan; Hwang, Yu‐Yan; Fung, James; Liu, Kevin Sze‐Hang; Gill, Harinder; Lam, Yuk‐Fai; Cheung, Ka‐Shing; Lie, Albert K W; Lai, Ching‐Lung; Kwong, Yok‐Lam; Yuen, Man‐Fung
• Is Part Of: American journal of gastroenterology. Volume 111:Number 12(2016)
• Publication Date: 2016-12
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.1038/ajg.2016.436
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : OBJECTIVES: Hepatitis B core‐related antigen (HBcrAg) is a novel serum marker that correlates with intrahepatic hepatitis B virus (HBV) activity. Its association with HBV reactivation in hepatitis B surface antigen (HBsAg)‐negative antibody to hepatitis B core antigen (anti‐HBc)‐positive patients undergoing high‐risk immunosuppressive therapy is undefined. METHODS: HBcrAg was measured in HBsAg‐negative, anti‐HBc‐positive Asian patients with undetectable HBV DNA, who participated in two prospective studies investigating HBV reactivation during rituximab‐containing chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT). Patients were monitored every 4 weeks for up to 2 years, with entecavir started when HBV reactivation, defined as HBV DNA ≥10 IU ml −1, developed. RESULTS: One hundred and twenty‐four HBsAg‐negative, anti‐HBc‐positive patients (rituximab, N =62; allogeneic HSCT, N =62) with a median follow‐up of 64 weeks (range: 4–104 weeks) were studied. HBV reactivation occurred in 31 patients, with a 2‐year cumulative reactivation rate of 40.4%. Serum HBcrAg was detected in 43 (34.7%) patients. Baseline HBcrAg positivity was significantly associated with HBV reactivation ( P =0.004, hazard ratio (HR): 2.94, 95% confidence interval (95% CI): 1.43–6.07). HBcrAg‐positive patients had a significantly higher 2‐year HBV reactivation rate than HBcrAg‐negative patients (71.8 vs. 31%, P =0.002). In the rituximab cohort, the HRs for positive HBcrAg and negative antibody to HBsAg for HBV reactivation were 3.65 and 2.84, respectively ( P =0.011, 95% CI: 1.35–9.86 and P =0.032, 95% CI: 1.10–7.37, respectively). CONCLUSIONS: Serum HBcrAg positivity is a significant risk factor of HBV reactivation in HBsAg‐negative, anti‐HBc‐positive patients undergoing high‐risk immunosuppressive therapy and can potentially have a role in identifying patients who will best benefit from prophylactic nucleoside analogue treatment.