Evaluation of Hepatitis Serology Screening Frequency and Viral Reactivation in Patients Followed with Biological Therapy or Cytotoxic Chemotherapy

Yıl 2024, Cilt: 31 Sayı: 3, 213 - 220, 29.09.2024

Arif Kılçar Atalay Doğru

https://doi.org/10.17343/sdutfd.1412752

Öz

Objective: Our study aimed to evaluate the results of hepatitis B and C serology screening before biological therapy and chemotherapeutic treatments in internal medicine clinics (rheumatology, medical oncology, and gastroenterology) by comparing between departments and investigating the virus reactivation status.
Material and Method: The study included 1147 patients aged 18 and over who were admitted to the medical oncology, rheumatology, and gastroenterology departments between 2019 and 2021 and received cytotoxic chemotherapy and biological treatment. HBsAg, Anti-HBs, Anti-HBc, and Anti-HCV data were used to screen for hepatitis. The departments were compared and evaluated based on the frequency of screening and reactivation.
Results: Before undergoing chemotherapy or biological therapy, 77% of patients in oncology, 40% in rheumatology, and 43% in gastroenterology were fully screened for hepatitis. The rates of incomplete screening were 16%, 48%, and 52%, respectively, while 3%, 10%, and 4% were never screened. In total, reactivation was observed in twelve patients (1.0%), while no reactivation was observed in 1135 patients (99.0%). A statistically significant correlation was found between the departments and the presence of reactivation (p<0.001). Reactivation was detected in 1 oncology patient and 11 rheumatology patients, while no reactivation was seen in all gastroenterology patients.
Conclusion: Although complete screening for viral hepatitis was recommended by the guidelines, it was observed that it was not implemented in clinical practice. It is important to note the need to improve screening rates, especially in populations receiving chemotherapy or biological therapy, where the risk of reactivation is high. Raising awareness about HBV and reminder practices about hepatitis B and C serology screening before chemotherapy and biological therapies for clinical applications may help to increase screening rates.

Anahtar Kelimeler

Hepatitis B, chemotherapy, reactivation, Biological therapy, hepatitis C

Biyolojik Tedavi veya Sitotoksik Kemoterapi İle Takip Edilen Hastalarda Hepatit Serolojisi Tarama Sıklığı ve Viral Reaktivasyonun Değerlendirilmesi

Öz

Amaç: Çalışmamızın amacı iç hastalıkları kliniğinde (romatoloji, medikal onkoloji ve gastroenteroloji) biyolojik tedavi ve kemoterapötik tedaviler öncesinde hepatit serolojisi taraması sonuçlarını bölümler arası karşılaştırma yaparak değerlendirmek ve virüs reaktivasyon durumunu araştırmaktır.
Gereç ve Yöntem: 2019 - 2021 tarihleri arasında medikal onkoloji, romatoloji ve gastroenteroloji bölümüne başvuran sitotoksik kemoterapi ve biyolojik tedavi verilen 18 yaş ve üzeri 1147 hasta çalışmaya dahil edilmiştir. Hepatit taraması için HBsAg, Anti-HBs, Anti-HBc ve Anti-HCV verileri kullanıldı. Bölümler tarama ve reaktivasyon sıklığına göre karşılaştırıldı ve değerlendirildi
Bulgular: Kemoterapi veya biyolojik tedavi almadan önce onkoloji hastalarının %77'si, romatoloji hastalarının %40'ı ve gastroenteroloji hastalarının %43'ü hepatit açısından tam olarak taranmıştır. Eksik tarama oranları sırasıyla %16, %48 ve %52 iken, %3, %10 ve %4 hiç taranmamıştır. Toplamda, on iki hastada (%1,0) reaktivasyon gözlenirken, 1135 hastada (%99,0) reaktivasyon gözlenmemiştir. Bölümler ile reaktivasyon varlığı arasında istatistiksel olarak anlamlı bir korelasyon bulunmuştur (p<0.001). Onkoloji hastalarının 1'inde ve romatoloji hastalarının 11'inde reaktivasyon tespit edilirken, gastroenteroloji hastalarının tamamında reaktivasyon görülmemiştir.
Sonuç: Kılavuzlarda hepatit için tam tarama önerilmesine rağmen, klinik uygulamada bunun hayata geçirilmediği görülmüştür. Özellikle reaktivasyon riskinin yüksek olduğu kemoterapi veya biyolojik tedavi alan popülasyonlarda tarama oranlarının iyileştirilmesi ihtiyacına dikkat çekmek önemlidir. HBV konusunda farkındalık yaratılması ve klinik uygulamalar için kemoterapi ve biyolojik tedaviler öncesi hepatit serolojisi tarama konusunda hatırlatıcı uygulamalar tarama oranlarının yükseltilmesine yardımcı olabilir.

Anahtar Kelimeler

Hepatit B, biyolojik tedavi, kemoterapi, reaktivasyon

Kaynakça

• 1. Aygen B, Demir AM, Gümüş M, et al. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol 2018;29(3):259-69.
• 2. Rehermann B, Ferrari C, Pasquinelli C, et al. The hepatitis B virus persists for decades after patients' recovery from acute viral hepatitis despite active maintenance of a cytotoxic T-lymphocyte response. Nat Med 1996;2(10):1104-8.
• 3. Staren ED, Essner R, Economou JS. Overview of biological response modifiers. Semin Surg Oncol 1989;5(6):379-84.
• 4. Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol 2016;22(2):219-37.
• 5. Law MF, Ho R, Cheung CK, et al. Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies treated with anticancer therapy. World J Gastroenterol 2016;22(28):6484-500.
• 6. Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015;148(1):215-9
• 7. Bozza C, Cinausero M, Iacono D, et al. Hepatitis B and cancer: A practical guide for the oncologist. Crit Rev Oncol Hematol 2016;98:137-46.
• 8. Wu YT, Li X, Liu ZL, et al. Hepatitis B virus reactivation and antiviral prophylaxis during lung cancer chemotherapy: A systematic review and meta-analysis. PLoS One 2017;12(6):e0179680.
• 9. Ramirez J, Duddempudi AT, Sana MM, et al. Screening for hepatitis B in patients with lymphoma. Proc (Bayl Univ Med Cent) 2015;28(4):438-42.
• 10. Castéra L, Bernard PH, Le Bail B, et al. Transient elastography and biomarkers for liver fibrosis assessment and follow-up of inactive hepatitis B carriers. Aliment Pharmacol Ther 2011;33(4):455-65.
• 11. Lubel JS, Angus PW. Hepatitis B reactivation in patients receiving cytotoxic chemotherapy: diagnosis and management. J Gastroenterol Hepatol 2010;25(5):864-71.
• 12. Day FL, Link E, Thursky K, et al. Current hepatitis B screening practices and clinical experience of reactivation in patients undergoing chemotherapy for solid tumors: a nationwide survey of medical oncologists. J Oncol Pract 2011;7(3):141-7.
• 13. Altuglu I, Soyler I, Ozacar T, et al. Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in Western Turkey. Int J Infect Dis 2008;12(3):239-44.
• 14. Nosotti L, D'Andrea M, Pitidis A, et al. Hepatitis C virus infection prevalence and liver dysfunction in a cohort of B-cell non-Hodgkin's lymphoma patients treated with immunochemotherapy. Scand J Infect Dis 2012;44(1):70-3.
• 15. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015;148(1):221-44.e3.
• 16. Hwang JP, Lok AS. Management of patients with hepatitis B who require immunosuppressive therapy. Nat Rev Gastroenterol Hepatol 2014;11(4):209-19.
• 17. Hwang JP, Fisch MJ, Zhang H, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract 2012;8(4):e32-9.
• 18. Engin B, Günay S, Binicier OB, et al. İmmünsüpresif hastalarda hepatit B virüs tarama sıklığı ve gerçek yaşam verileri. FNG & Bilim Tıp Dergisi 2016;2(4):256-9.
• 19. Bozkurt İ, Bektaş A. Anti-TNF alfa kullanan hastalarda hepatit B reaktivasyonunun değerlendirilmesi. Dicle Med J 2019;46 (3):553 –7.
• 20. Knöll A, Boehm S, Hahn J, et al. Reactivation of resolved hepatitis B virus infection after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2004;33(9):925-9.
• 21. Bessone F, Dirchwolf M. Management of hepatitis B reactivation in immunosuppressed patients: An update on current recommendations. World J Hepatol 2016;8(8):385-94.
• 22. Cheng AL, Hsiung CA, Su IJ, et al. Steroid-free chemotherapy decreases the risk of hepatitis B virus (HBV) reactivation in HBV carriers with lymphoma. Hepatology 2003;37(6):1320-8.
• 23. Cholongitas E, Haidich AB, Apostolidou-Kiouti F, et al. Hepatitis B virus reactivation in HBsAg-negative, anti-HBc-positive patients receiving immunosuppressive therapy: a systematic review. Ann Gastroenterol 2018;31(4):480-90.
• 24. Koskinas JS, Deutsch M, Adamidi S, et al. The role of tenofovir in preventing and treating hepatitis B virus (HBV) reactivation in immunosuppressed patients. A real-life experience from a tertiary center. Eur J Intern Med 2014;25(8):768-71.