scholarly journals Post-Autotransplant Hepatitis B Virus (HBV) Reactivation in Lymphoma and Multiple Myeloma Patients with Hepatitis B Surface Antigen-Positive or Resolved HBV Infection

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1196-1196
Author(s):  
Jieun Jang ◽  
Hyunsung Park ◽  
Jungyeon Lee ◽  
Yundeok Kim ◽  
Soo Jeong Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Hbv Infection ◽  
Hbv Reactivation ◽  
B Virus ◽  
Conditioning Regimens ◽  
Anti Cd20

Abstract Background: Although hepatitis B virus (HBV) reactivation in patients with hepatitis B surface antigen (HBsAg)-positive or resolved HBV infection (HBsAg-negative and hepatitis B core antibody [anti-HBc]-positive) undergoing anticancer therapy with or without rituximab has been frequently reported, few studies have evaluated the risk of HBV reactivation in patients receiving autologous stem cell transplantation (ASCT). We studied the rate of hepatitis and HBV reactivation after ASCT in lymphoma and multiple myeloma (MM) patients with HBsAg-positive or resolved HBV infection. Methods & Materials: Medical records of patients who diagnosed with lymphoma or MM and received ASCT between November 2005 and April 2014 in Severance hospital were retrospectively analyzed. HBV status was screened routinely at ASCT and when viral-related hepatitis was suspected after ASCT. Hepatitis was defined as a 3-fold or greater increase in serum alanine transaminase (ALT) that exceeded the reference range (>46 IU/L) or an absolute increase of ALT to more than 100 IU/L. HBV reactivation was defined as elevation of serum HBV-DNA level more than 1 log IU/L from baseline in HBsAg(+) patients. In case of resolved HBV patients, positive conversion of HBsAg (reverse seroconversion) with or without increase of ALT was defined as HBV reactivation. Hepatitis and HBV reactivation occurred before 1 year after ASCT was considered ASCT-related in this study. Result: A total of 297 patients (196 lymphoma and 101 MM) were studied. Median age at diagnosis was 47 years (range 16-64). A male to female ratio was 1.36:1. Most common subtype of lymphoma was diffuse large B-cell lymphoma (DLBCL, n=111). The median duration from diagnosis to ASCT was 475 days (range 105-5230) and 175 days (range 39-5400) in lymphoma and MM patients, respectively. Busulfan-based (n= 161, 82.1%) conditioning regimens were commonly used in lymphoma patients and melphalan-based (n=101, 100%) conditioning regimens were used in MM patients. The patients with HBsAg(-) did not received a routine anti-HBV prophylaxis regardless of the presence of anti-HBc. Nine patients did not tested for HBV at ASCT. Among 274 patients with HBsAg(-), 110 patients were anti-HBc(+) (resolved HBV infection) and 161 patients were anti-HBc(-). Within 1 year after ASCT, 48 of anti-HBc(+) and 71 of anti-HBc(-) patients experienced hepatitis (43.6% vs. 44.1%, p>0.999). The most common cause of hepatitis was drug-related (n= 81, 66.9%). There was no HBsAg reverse seroconversion within 1 year after ASCT. After 1 year, Only one patient with anti-HBc(+) experienced HBV reactivation at days 763 after ASCT and 3 patients with anti-HBc(-) showed HBsAg reverse seroconversion at days 406, 457 and 1172 post-transplant. In the subset of 178 lymphoma patients with HBsAg(-), 90 patients had a history of previous use of anti-CD20 monoclonal antibody, of whom 37 patients were anti-HBc(+). Twelve of anti-HBc(+) and 24 of anti-HBc(-) patients experienced hepatitis (32.4% vs. 45.3%, p=0.276) but there was no HBV reactivation related hepatitis within 1 year after ASCT. Among 14 patients with HBsAg(+) at ASCT, 13 patients received rituximab-containing chemotherapy before ASCT. They had received prophylactic HBV therapy with lamivudine (n=6), telbivudine (n=4), clevudine (n=2), adefovir (n=1) and tenofovir (n=1). Among them, 3 patients with telbivudine (n=1, 25%), clevudine (n=1, 50%) and lamivudine (n=1, 16.7%) experienced HBV reactivation at days 36, 161 and 204 after ASCT. Conclusion: Our data suggest that ASCT-related HBV reactivation is rare in lymphoma and MM patients with resolved HBV infection regardless of previous anti-CD20 therapy. Routine anti-HBV prophylaxis is not necessary for patients with resolved HBV infection. In case of HBsAg(+) patients, antiviral prophylaxis with lamivudine, clevudine, or telbivudine may not be sufficient to prevent HBV reactivation after ASCT. More potent antiviral agents such as adefovir or tenofovir should be considered. Figure 1 Figure 1. Characteristics of 7 patients with HBV reactivation or HBsAg reverse seroconversion after ASCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals Rituximab increases the risk of hepatitis B virus reactivation in non-Hodgkin lymphoma patients who are hepatitis B surface antigen-positive or have resolved hepatitis B virus infection in a real-world setting: a retrospective study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7481 ◽  
Author(s):  
Yu-Fen Tsai ◽  
Ching-I Yang ◽  
Jeng-Shiun Du ◽  
Ming-Hui Lin ◽  
Shih-Hao Tang ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hodgkin Lymphoma ◽  
Hepatitis B Surface Antigen ◽  
Hbv Infection ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Non Hodgkin Lymphoma ◽  
B Virus ◽  
Hepatitis Flare

Background Hepatitis B virus (HBV) reactivation with a hepatitis flare is a common complication in lymphoma patients treated with immunotherapy and/or chemotherapy. Anti-HBV prophylaxis is suggested for non-Hodgkin lymphoma (NHL) patients undergoing rituximab therapy, even those with resolved HBV infection. Since anti-HBV prophylaxis for patients with resolved HBV infection is not covered by national health insurance in Taiwan, a proportion of these patients receive no prophylaxis. In addition, late HBV reactivation has emerged as a new issue in recent reports, and no consensus has been reached for the optimal duration of antiviral prophylaxis. Thus, the aim of our study was to investigate the incidence and outcomes of HBV reactivation in NHL patients in a real-world setting and to study the frequency of late HBV reactivation. Materials Non-Hodgkin lymphoma patients who received rituximab and/or chemotherapy at our institute between January 2011 and December 2015 and who were hepatitis B surface antigen (HBsAg)- or hepatitis B core antibody (HBcAb)-positive were reviewed retrospectively. Results A total of 388 patients were screened between January 2011 and December 2015. In total, 196 patients were excluded because HBsAg was not assessed, HBcAb was negative or not assessed, or they were not treated with immunosuppressive therapy. Finally, the retrospective study included 62 HBsAg-positive NHL patients and 130 NHL patients with resolved HBV infection (HBsAg-negative and HBcAb-positive). During a median 30.5-month follow-up period, seven patients experienced HBV reactivation, five of whom had a hepatitis flare. The incidence of HBV reactivation did not significantly differ between the HBsAg-positive patients and the resolved HBV infection population without anti-HBV prophylaxis (4.8% vs. 3.1%, P = 0.683). All patients with HBV reactivation were exposed to rituximab. Notably, late HBV reactivation was not uncommon (two of seven patients with HBV reactivation events, 28.6%). Hepatitis B virus reactivation did not influence the patients’ overall survival. An age ≥65 years and an advanced disease stage were independent risk factors for poorer overall survival. Conclusion The incidence of HBV reactivation was similar between the HBsAg-positive patients with antiviral prophylaxis and the resolved HBV infection population without anti-HBV prophylaxis. All HBV reactivation events occurred in NHL patients exposed to rituximab. Late reactivation was not uncommon. The duration of regular liver function monitoring for more than 1 year after immunosuppressive therapy or after withdrawal of prophylactic antiviral therapy should be prolonged. Determining the exact optimal duration of anti-HBV prophylaxis is warranted in a future prospective study for NHL patients treated with rituximab-containing therapy.

Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without Rituximab

2009 ◽  
Vol 27 (4) ◽  
pp. 605-611 ◽  
Author(s):  
Winnie Yeo ◽  
Tung C. Chan ◽  
Nancy W.Y. Leung ◽  
Wai Y. Lam ◽  
Frankie K.F. Mo ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
B Cell Lymphoma ◽  
Anticancer Therapy ◽  
Hbv Dna ◽  
Core Antigen ◽  
Hbv Reactivation ◽  
B Virus

Purpose Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication in cancer patients with chronic HBV (hepatitis B surface antigen [HBsAg] positive) undergoing cytotoxic chemotherapy. In patients who have resolved HBV (HBsAg negative and antibody to hepatitis B core antigen [anti-HBc] ± antibody to hepatitis B surface antigen [anti-HBs] positive), such incidence has been much less common until recent use of rituximab. In this study on HBsAg-negative/anti-HBc–positive lymphoma patients, the objectives were to determine the HBV reactivation rate in patients treated with rituximab-containing chemotherapy and to compare it with the rate in patients treated without rituximab. Patients and Methods Between January 2003 and December 2006, all patients diagnosed with CD20+ diffuse large B-cell lymphoma (DLBCL) had HBsAg determined before anticancer therapy. They were treated with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or rituximab plus CHOP (R-CHOP). HBsAg-negative patients had anti-HBc determined; serum was stored for anti-HBs and HBV DNA. All patients were observed for HBV reactivation, which was defined as detectable HBV DNA with ALT elevation during and for 6 months after anticancer therapy. Results Among 104 CD20+ DLBCL patients, 80 were HBsAg negative. Of the latter, 46 patients (44.2%) were HBsAg negative/anti-HBc positive; 25 of these patients were treated with CHOP, and none had HBV reactivation. In contrast, among the 21 patients treated with R-CHOP, five developed HBV reactivation, including one patient who died of hepatic failure (P = .0148). Exploratory analysis identified male sex, absence of anti-HBs, and use of rituximab to be predictive of HBV reactivation. Conclusion Among HBsAg-negative/anti-HBc–positive DLBCL patients treated with R-CHOP, 25% developed HBV reactivation. Close monitoring until at least 6 months after anticancer therapy is required, with an alternative approach of prophylactic antiviral therapy to prevent this potentially fatal condition.

scholarly journals Low Risk of Hepatitis B Virus Reactivation in HBsAg-negative/Anti-HBc–positive Carriers Receiving Rituximab for Rheumatoid Arthritis: A Retrospective Multicenter Italian Study

2016 ◽  
Vol 43 (5) ◽  
pp. 869-874 ◽  
Author(s):  
Valentina Varisco ◽  
Mauro Viganò ◽  
Alberto Batticciotto ◽  
Pietro Lampertico ◽  
Antonio Marchesoni ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hepatitis B Surface Antigen ◽  
Hbv Dna ◽  
Hbv Infection ◽  
Core Antigen ◽  
Hbv Reactivation ◽  
Serum Hbsag ◽  
B Virus

Objective.Patients with resolved hepatitis B virus (HBV) infection, i.e., hepatitis B surface antigen (HBsAg)-negative/antihepatitis B core antigen (anti-HBc)-positive, undergoing rituximab (RTX)-based chemotherapy for hematological malignancies without anti-HBV prophylaxis are at risk of HBV reactivation, but the risk in such patients receiving RTX for rheumatological disorders is not clear. We evaluated this risk in HBsAg-negative/anti-HBc–positive patients with rheumatoid arthritis (RA) undergoing RTX without prophylaxis.Methods.Thirty-three HBsAg-negative/anti-HBc–positive outpatients with RA with undetectable HBV DNA by sensitive PCR assay [73% women, median age 60 years, 85% with HBsAg antibodies (anti-HBs), 37% with antihepatitis B envelope antigen] received a median of 3 cycles of RTX (range 1–8) over 34 months (range 0–80) combined with disease-modifying antirheumatic drugs (DMARD) without prophylaxis. All underwent clinical and laboratory monitoring during and after RTX administration, including serum HBsAg and HBV DNA measurements every 6 months or whenever clinically indicated.Results.None of the patients seroreverted to HBsAg during RTX treatment, but 6/28 (21%) showed a > 50% decrease in protective anti-HBs levels, including 2 who became anti-HBs–negative. One patient (3%) who became HBV DNA-positive (44 IU/ml) after 6 months of RTX treatment was effectively rescued with lamivudine before any hepatitis flare occurred. Among the 14 patients monitored for 18 months (range 0–70) after RTX discontinuation, no HBV reactivation was observed.Conclusion.The administration of RTX + DMARD in patients with RA with resolved HBV infection leads to a negligible risk of HBV reactivation, thus suggesting that serum HBsAg and/or HBV DNA monitoring but not universal anti-HBV prophylaxis is justified.

scholarly journals Seroprevalence of Hepatitis B Virus among antenatal clinic attendees in Gamawa Local Government Area, Bauchi State, Nigeria

2019 ◽  
Author(s):  
Garba Umar Mustapha ◽  
Abdulrasul Ibrahim ◽  
Muhammad Shakir Balogun ◽  
Chukwuma David Umeokonkwo ◽  
Aisha Indo Mamman
Keyword(s):  
Hepatitis B Virus ◽  
Local Government ◽  
Hepatitis B ◽  
Pregnant Women ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Local Government Area ◽  
Hbv Infection ◽  
Risk Of Death ◽  
B Virus

Abstract Background: Hepatitis B is a potentially life-threatening liver infection and a major global health problem. It causes chronic infection and puts people at high risk of death from cirrhosis and liver cancer. WHO estimated 257 million people are living with hepatitis B virus (HBV) infection and in 2015 alone HBV resulted in to 887,000 deaths globally. We determined the prevalence and associated factors of hepatitis B virus infection among Antenatal Care (ANC) attendees in Gamawa Local Government Area, Bauchi State. Methods: We conducted a descriptive cross-sectional, health facility-based study between March and April 2018. We used systematic random sampling technique to recruit 210 pregnant women aged 15-49 years. With a structured questionnaire, we interviewed the respondents and collected blood sample to test for hepatitis B surface antigen. We calculated frequencies, means, proportions, and tested for associations using Epi Info 7.2 and Microsoft Excel. Results: The mean age of respondents was 24.5 ± 6.0 years; 53.3% of whom were younger than 25 years. All were married, 87.1% had no formal education and up to 90.5% were employed. Overall, 6.7% tested positive for HBsAg; women aged ≥35 years had the highest prevalence (10.5%). None with tertiary education tested positive and women married before 18 years had 6.5% prevalence. Conclusions: The prevalence of HBsAg among pregnant women in Gamawa LGA was 6.7% which is quite lower than the national prevalence reported. We recommended improved surveillance of HBV infection and screening of women attending ANC. Keywords: Hepatitis B virus, Hepatitis B Surface antigen, Prevalence, Pregnancy, Health facilities, Hepatitis B

Hepatitis B Virus Reactivation by Immunosuppressive Therapy in Patients with Autoimmune Diseases: Risk Analysis in Hepatitis B Surface Antigen-negative Cases

2011 ◽  
Vol 38 (10) ◽  
pp. 2209-2214 ◽  
Author(s):  
MASARU KATO ◽  
TATSUYA ATSUMI ◽  
TAKASHI KURITA ◽  
TOSHIO ODANI ◽  
YUICHIRO FUJIEDA ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Autoimmune Diseases ◽  
Immunosuppressive Therapy ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Hbv Dna ◽  
Core Antigen ◽  
Hbv Reactivation ◽  
B Virus

Objective.To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases.Methods.Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8–124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy, HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks.Results.HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24–168.50) mIU/ml vs 99.94 (range 0.00–5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and 1 died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in 1 patient.Conclusion.Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk.

Possible transmission of hepatitis B virus between spouses and their children in Babol, Northern Iran

2007 ◽  
Vol 37 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Mohammad Reza Hasanjani Roushan ◽  
Minoo Mohraz ◽  
Ali Akbar Velayati
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Family Members ◽  
Hbv Infection ◽  
Hepatitis B E Antigen ◽  
Northern Iran ◽  
Hbv Markers ◽  
B Virus

To determine the possible routes of transmission of hepatitis B virus (HBV) infection between spouses and their children in Babol, Northern Iran, the spouses of 54 infected husbands and 49 wives without any evidence of HBV infection in their family members were evaluated from March 1998 to April 2005. All of these cases were hepatitis B surface antigen and anti-hepatitis B 'e' antigen positive. Mean duration of marriage for husbands was 14.4±6.49 and for wives12.46±6.24 years. Past HBV infection was found in 46.3% wives of infected husbands and in 65.3% husbands of infected wives ( P = 0.074). HBV markers were seen in 32.5% children of infected fathers and 64.5% children of infected mothers ( P = 0.0001). HBV carrier rates in boys and girls of infected mothers were significantly higher than in those of infected fathers ( P = 0.002 and P = 0.0001, respectively). The results show that transmission of HBV between spouses and their children were the main routes of transmission of HBV in our region.

scholarly journals Seroprevalence of hepatitis B virus amongst patients attending selected hospitals in Niger State, Nigeria

2021 ◽  
Vol 01 (01) ◽  
Author(s):  
Aisha Adamu ◽  
Faruk Kuta
Keyword(s):  
Hepatitis B Virus ◽  
Blood Transfusion ◽  
Hepatitis B ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Hbv Infection ◽  
Awareness Campaigns ◽  
Test Kit ◽  
B Virus ◽  
History Of

Hepatitis B virus (HBV) is a major public health problem globally and accounts for about one million deaths worldwide annually. This study determined the seroprevalence, distribution of HBV infection, and factors associated with the infection amongst patients attending selected hospitals in Niger State. A total of 500 blood samples were collected from five selected hospitals in Niger state. The samples were screened using Hepatitis B Surface Antigen (HBsAg) test kit for the qualitative detection of Hepatitis B Surface Antigen in serum. Prevalence of Hepatitis B infection was 13.0% cumulatively in the study area. Female participants had a higher prevalence (6.8%) of HBsAg infection compared to their male counterparts with 6.2%. Participants within the 41- 50 years’ age group recorded a higher rate of infection (5.2%), while those ≥ 50 years had a lower prevalence of (2.3%). The civil servants had a higher percentage prevalence of 6.4% followed by housewives and the least was observed with participants who are students. Patients without a history of blood transfusion recorded a higher percentage prevalence (7.8%) compared to those with a history of blood transfusion (5.2%). The results reveal that participants with polygamous family types recorded a higher prevalence of HBV infection (11.4%) compared to those belonging to the monogamous type (1.6%). The results obtained from this study suggest that HBV is in circulation in the study areas; thus necessitating more awareness campaigns among the general population about HBV and its modes of transmission and associated risk factors

Risk of Hepatitis B Virus (HBV) Reactivation and the Role of Anti-Viral Prophylaxis in Multiple Myeloma Patients with HBV Infection in the Era of Novel Therapies.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3882-3882
Author(s):  
Dawn Mya ◽  
Shuting Han ◽  
Yeow Tee Goh ◽  
Daryl Tan
Keyword(s):  
Multiple Myeloma ◽  
Viral Load ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hbv Dna ◽  
Hbv Infection ◽  
Hbv Reactivation ◽  
B Virus ◽  
Lamivudine Prophylaxis

Abstract Abstract 3882 Poster Board III-818 Introduction Patients with hepatitis B virus (HBV) infection, defined by the presence of HBV surface antigen (HBsAg), have an increased risk of HBV reactivation when they are on immunosuppressive treatment for multiple myeloma (MM). Although there is no guideline for MM patients with HBV infection, current lymphoma guidelines do recommend that these patients should receive antiviral prophylaxis during and after chemotherapy. Of late, the advent of bortezomib in the management of MM has resulted in a high reported incidence of variecella-zoster reactivation. The risk of HBV reactivation in MM patients with HBV infection undergoing treatment has not been previously studied. As HBV infection is endemic in Asia, we sought to evaluate the prevalence of HBV infection in our patients, the incidence of its reactivation especially in patients receiving bortezomib and the role of anti-viral prophylaxis. Methods Previously untreated MM patients diagnosed from 2000-2008 who were tested for HBsAg in our institution were included. Hepatitis attributable to HBV reactivation was defined as an increase in HBV DNA levels of tenfold, or an absolute increase greater than105 copies/ml in the HBV DNA level. HBV infected patients were prospectively followed. 33% of all patients have been exposed to bortezomib, while 26% received high dose therapy with autologous stem cell transplantation (HDT/ASCT). Results 243 untreated MM patients were identified. The prevalence of HBV infection is 5.8% (14/243). 6 (43%) HBV infected patients had detectable HBV DNA viral load (>3 log) at baseline. All 6 patients had normal baseline liver function tests and received lamivudine prophylaxis. All 14 HBV infected patients went on to receive systemic therapy for MM, with continual monitoring of HBV DNA viral load and liver enzymes for viral reactivation. 4 patients with undetectable HBV DNA load did not receive anti-viral prophylaxis. Of these 14 patients, 3 (21%) who had been on lamivudine prophylaxis had reactivation of the virus, with 1 dying from it, and 1 having emergence of a mutant viral strain. Two of them had no detectable viral load at presentation. Two patients reactivated 3 and 5 months after HDT/ASCT, while 1 reactivated immediately after a bortezomib/ doxil salvage regimen. Conclusion The risk of HBV reactivation appeared to be commonest during the immune reconstitution phase after HDT/ASCT. Although the majority of patients with HBV infection and not receiving HDT/ASCT do not reactivate, the risk may not negligible when bortezomib is used (7%). Undetectable HBV DNA and the use of anti-viral prophylaxis do not appear to preclude reactivation. The optimal use of anti-viral prophylaxis, particularly if bortezomib is given, should be further evaluated. This is particularly relevant in the current era where bortezomib plays a dominant role in the treatment of MM, and especially in endemic regions where the incidence of HBV infection is high. Disclosures: No relevant conflicts of interest to declare.

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