scholarly journals Unique evolution of chronic lymphoproliferative disorders associated with hepatitis B virus infection and viral reactivation – a major concern with multidisciplinary approach

2015 ◽  
Vol 18 (4) ◽  
pp. 143-151
Author(s):  
Cristina Maria Ciufu ◽  
◽  
Lavinia Lipan ◽  
Minodora Onisâi ◽  
Mihaela Găman ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Multidisciplinary Approach ◽  
Lymphoproliferative Disorders ◽  
Hbv Infection ◽  
Viral Reactivation ◽  
Antiviral Prophylaxis ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
B Virus

Background. The association of hepatitis B virus (HBV) infection with chronic lymphoproliferative disorders becomes a matter of debate, with multidisciplinary approach due to possible viral reactivation after immuno-chemotherapy. Material and methods. We studied two patient groups with chronic lymphoproliferative disorders, one with HBV infection (HbsAg+ and HbsAg- HbcAb+ HBs+/-) – 43 patients and one without viral infection (104 patients). Clinical and paraclinical parameters, therapy, survival of both groups were compared; the occurrence of viral reactivation was followed. Data were statistically analyzed. Results and discussion. The HBV infection group included HbsAg+-ve patients (72%) and occult HBV infection patients. The median onset age for lymphoproliferative disorders HBV+-ve was significantly younger (55 vs. 61 years, p<0.05). Hepatomegaly and abdominal adenopathies were more frequent in HBV patients (p=0.003, respectively p=0.027). Hepatic function was altered in HBV patients both at disease onset (AST p=0.0213, GGT p=0.0002) and after first line therapy (AST p=0.0003, ALT p=0.019, FA p=0.008, GGT p=0.000, total bilirubine p=0.043, INR p=0.0003 and albumine p=0.05). The risk of hepatic dysfunction after first line therapy is increased 6 times by HBV infection (p=0.0009, OR=6.000, 95%CI: 1.9121-18.8272), which could negatively impact the hematological disease evolution by lowering therapeutic dose, leading to an inferior treatment result. Viral reactivation occurred both in HbsAg+-ve (21.42%) and HbsAg- HbcAb+-ve patients (60%). None of the occult carriers received antiviral prophylaxis. Whithin our occult carrier group, the viral reactivation percentage is high, therefore we would reccomand antiviral prophylaxis. The overall survival was similar in both group of patients. Conclusions. HBV-positive chronic lymphoproliferative disorders could become a new pathological entity, with individual clinical features and outcome and possibly with negative impact on long term survival. Antiviral prophylaxis for occult carriers could significantly reduce the viral reactivation rate and therefore the therapeutic guidelines should be revised.

scholarly journals New Markers in Monitoring the Reactivation of Hepatitis B Virus Infection in Immunocompromised Hosts

Viruses ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 783 ◽  
Author(s):  
Valentina Svicher ◽  
Romina Salpini ◽  
Vincenzo Malagnino ◽  
Lorenzo Piermatteo ◽  
Mohammad Alkhatib ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Immunosuppressive Treatment ◽  
Hbv Infection ◽  
Viral Reactivation ◽  
Hbv Reactivation ◽  
Therapeutic Implications ◽  
B Virus ◽  
New Biomarkers ◽  
Immunocompromised Hosts

Hepatitis B virus (HBV) persistence is at the basis of HBV reactivation as a consequence of chemotherapy and immunosuppressive treatments. The identification of early viral replication indicators and markers of effective HBV immunological control would be useful in monitoring patients who are at risk of potential viral reactivation during the course of immunosuppressive treatment. Currently, international guidelines have shared some criteria to identify patients with a low, medium or high risk of HBV reactivation; however, permanently placing a patient in a definitive category is not always easy. More often, patients move from one category to another during the course of their immunosuppressive treatment; therefore, in many cases, there are no precise indicators or tools for monitoring possible reactivation and establishing the duration and suspension of antiviral prophylaxis. Historically, the sequence of HBV antigens and antibodies and HBV DNA levels has been used to evaluate the different stages of the acute and chronic phases of an HBV infection. In the last few years, new biomarkers, such as anti-HBs and anti-HBc titres, HBV core-related antigen (HBcrAg), ultra-sensitive HBsAg evaluation and HBV RNA, have been used in patients with an HBV infection to evaluate their diagnostic and prognostic potential. The aim of this review is to evaluate the published results on the use of new infection markers in the diagnosis and monitoring of HBV reactivation over the course of immunosuppressive treatments. Moreover, the importance of viral genotypic studies was emphasized, given the diagnostic and therapeutic implications of the mutational profiles of HBsAg during the HBV reactivation phase.

scholarly journals Pleural Effusion Related to Chronic Hepatitis B Virus Reactivation: A Rare Association

2021 ◽  
Author(s):  
Ana Oliveira ◽  
Diana Valadares ◽  
Filipe Nery
Keyword(s):  
Hepatitis B Virus ◽  
Pleural Effusion ◽  
Hepatitis B ◽  
Antiviral Treatment ◽  
Public Health Problem ◽  
Hbv Infection ◽  
Viral Reactivation ◽  
Major Public Health Problem ◽  
Chronic Hepatitis B Virus ◽  
B Virus

Despite worldwide vaccination campaigns, hepatitis B virus (HBV) infection remains a major public health problem. The natural history ranges from asymptomatic infection to severe liver injury or failure, chronic complications or reactivation episodes. The effects of HBV on the organism are immunomediated, possibly triggering extrahepatic manifestations. Since 1971, only a few cases of pleural effusion related to HBV infection have been described. We report HBV-associated pleural effusion occurring during a viral reactivation episode. Antiviral treatment directed towards pleural effusion related to HBV infection should be dictated by underlying liver disease severity and not pleural effusion severity.

scholarly journals Pediatric eosinophilic esophagitis: a review for the clinician

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Simona Barni ◽  
Stefania Arasi ◽  
Carla Mastrorilli ◽  
Luca Pecoraro ◽  
Mattia Giovannini ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Multidisciplinary Approach ◽  
Unmet Needs ◽  
Clinical Manifestations ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Therapy Option ◽  
Esophageal Dysfunction ◽  
Histological Remission

AbstractEosinophilic esophagitis (EoE) is a chronic clinical-pathologic disease characterized by eosinophilic infiltration of the esophageal epithelium with esophageal dysfunction symptoms.EoE can occur at any age and has different clinical manifestations depending on the age onset.To date, esophago-gastroduodenal endoscopy (EGD) with biopsy is the gold-standard for EoE diagnosis.According to the recent consensus guidelines, proton pump inhibitors, corticosteroids and elimination diets could be a first-line therapy option. The aim of the treatment is clinical and histological remission for preventing long-lasting untreatable fibrosis.A multidisciplinary approach (allergist, gastroenterology, dietitian, and pathologist) is recommended for managing patients affected by EoE, given the complexity of its treatment.This review will provide a practical guide to assist pediatricians treating children with EoE.Moreover, it highlights the unmet needs in diagnosis and treatment that require urgent attention from the scientific community in the aim of improving the management of patients with EoE.

scholarly journals Clinical Analysis of Immunodeficiency-Associated Lymphoproliferative Disorders in a Single Institution

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5398-5398
Author(s):  
Mizuki Watanabe ◽  
Junya Kanda ◽  
Yasuyuki Arai ◽  
Momoko Nishikori ◽  
Masakatsu Hishizawa ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Lymphocyte Count ◽  
Research Funding ◽  
Poor Prognosis ◽  
Immunosuppressive Agents ◽  
Biological Response ◽  
Lymphoproliferative Disorders ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Abstract Background Recent progress in medicine faces more patients to iatrogenic immunosuppressive state, which increases the risk of following immunodeficiency-associated lymphoproliferative disorders (LPD), such as post-transplant lymphoproliferative disorders (PTLD) which arise after solid organ or hematopoietic stem cell transplantation (HSCT), and other lymphoid proliferations or lymphomas which arise in patients treated with immunosuppressive agents for any reasons. Methotrexate for patients with rheumatoid arthritis (RA) has been the most discussed immunosuppressive agent associated with iatrogenic LPD. Nevertheless, the number of patients treated with other immunosuppressive agents such as biological response modifiers for RA and calcineurin inhibitors after HSCT has recently increased and clinical assessment of iatrogenic-LPD under this recent immunosuppressive setting is still limited. Clinical prognostic factors remain controversial due to the heterogeneity of this disease concept, patients' background and treatment. Methods: A total of 71 patients diagnosed as iatrogenic immunodeficiency-associated lymphoproliferative disorders (PTLD, n=26; other LPD, n=45) over last 20 years in Kyoto University Hospital were reviewed. Cox regression analysis was used to examine the impact of patient characteristics including immunological backgrounds and tumor status on outcomes. Results: Median age at diagnosis of LPD was 63 (range, 3-83; PTLD, 50; other LPD, 66). Regarding the PTLD patients, 12 were recipients of liver transplantation, 8 were of HSCT, 4 were of lung and 2 were of kidney transplantation. Background diseases of the other LPD were RA in 43, systemic lupus erythematosus in 1 and systemic sclerosis in 1. Median time from the initiation of immunosuppressive agents to LPD diagnosis was 82 months (range, 1.5-348.5; PTLD, 35.4; other LPD, 116.5). The number of immunosuppressive agents given at LPD diagnosis was 0 in 1 patient, 1 in 14, 2 in 42, 3 in 12 and 4 in 1 patient. Twenty-nine percentage of those receiving multiple immunosuppressive agents were administered methotrexate in combination with PSL or biological response modifiers. Ann Arbor stage at diagnosis was I in 8 patients, II in 13, III in 20 and IV in 28 patients. Histologic subtypes of PTLD were monomorphic (n=19), polymorphic (n=4), and non-destructive PTLD (n=3). Pathological diagnosis of other LPD were DLBCL (n=20), polymorphic LPD (n=5), classical Hodgkin lymphoma (n=6), Hodgkin-like lesion (n=3), Burkitt lymphoma (n=1), EBV-positive mucocutaneous ulcer (n=3), and other B-cell lymphomas (n=7). EBER in situ hybridization was positive in 38 (63.3%) and systemic EBV reactivation was detected in 17 (43.6%).First line therapy included reduction of immunosuppressive agents without chemotherapy in 33 patients (PTLD, n=4; other LPD, n=29), RTX-containing chemotherapy in 23 (PTLD, n=14; other LPD, n=9), other chemotherapies in 7 (PTLD, n=4; other LPD, n=3), radiation therapy in 2, and no additional treatment in 2 patients.After the first line therapy, complete remission was achieved in 35 patients, partial response in 13, and stable or progressive disease in 14. A total of 4 patients died during the first line therapy. Five-year survival rate was 49.9% (PTLD, 39.0%; other LPD, 54.0%; P=0.101).Multivariate analysis showed that low number of lymphocyte count (&lt; 890/µl, median lymphocyte count) at diagnosis (HR, 5.55; P=0.013), hypoalbuminemia (serum albumin value &lt;3.2 g/dl) at diagnosis (HR, 6.36; P=0.015) and higher IPI (high-risk group vs others, HR, 2.71; n=0.021) were risk factors for poor prognosis. In subgroup analysis for PTLD, low IgG (&lt;825 mg/dl, lowest limiting value of our center) was also an independent prognostic factor for inferior outcome (HR, 15.5; P=0.011). Conclusions: Overall survival of immunodeficiency-associated lymphoproliferative disorders under recent immunosuppressive settings, especially PTLD, was still poor. We found that low number of lymphocyte count could be a new risk factor for poor prognosis, along with known factors as IPI and hypoalbuminemia. Low IgG value was also suggested to be a prognostic factor for inferior outcome in PTLD patients. Figure. Figure. Disclosures Nishikori: Eisai: Research Funding; Ono Pharmaceuticals: Research Funding.

scholarly journals Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus infection in South Africa

2018 ◽  
Author(s):  
Jolynne Mokaya ◽  
Edward Burn ◽  
Cynthia Raissa Tamandjou ◽  
Dominique Goedhals ◽  
Eleanor Barnes ◽  
...  
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hbv Infection ◽  
Antiviral Prophylaxis ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
B Virus ◽  
Mother To Child

ABSTRACTIn light of sustainable development goals for 2030, an important priority for Africa is to have affordable, accessible and sustainable hepatitis B virus (HBV) prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies. We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective. S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3,940 per infection avoided. S3 led to more infections and higher costs. Given the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa.

Sign in / Sign up

Export Citation Format

Share Document