Many people infected with hepatitis B (HBV) have few or no symptoms, and do not realize that they have the disease. The virus can live for years in the liver until it is reactivated by conditions that suppress the immune system.
Chemotherapy for cancer treatment is one of the most common causes of reactivation, according to an article by Dr. Maria Luisa Manzano-Alonso and colleagues in Spain. “All types of drugs used in CMT [chemotherapy] have been involved in HBV reactivation,” she reported.
The U. S. National Library of Medicine's PubMed web site explains that HBV can be spread by exposure to bodily fluids of an infected person. Transmission routes include sexual contact, shared personal items, unclean needles, and blood contact in health care settings.
Asia, Africa, and the Caribbean have high infection rates. Some people have no symptoms, others feel ill for a period of days or weeks. Possible symptoms include appetite loss, fatigue, low-grade fever, muscle and joint aches, nausea, vomiting, and jaundice.
If the immune system is not able to kill all the virus particles, the patient develops chronic hepatitis B. Individuals with chronic hepatitis B can transmit the disease even if they have no symptoms. The infection causes inflammation of the liver, which can lead to cirrhosis, liver cancer, and death.
Manzano-Alonso explained that HBV reactivation has a wide range of outcomes. As in the original infections, some people have no symptoms. Others develop life-threatening liver failure.
Blood tests for HBV are recommended for all patients who receive therapy. Prophylactic therapy with lamivudine is recommended for those who test positive for the HBV surface antigen, HBsAg. Supporting data include the following:
1. In eight retrospective case studies of patients with positive HBsAg and chemotherapy, 56 percent of those who did not receive prophylactic therapy experienced HBV reactivation, compared to only 2.4 percent of those who did receive prophylaxis.
2. In a prospective controlled clinical trial of patients with positive HBsAg and chemotherapy, those who did not receive prophylactic therapy had a 53 percent rate of HBV reactivation, 47 percent developed hepatitis, and 7 percent died. The patients who received prophylactic therapy had no reactivation, hepatitis, or death.
Once reactivation occurs, it can still be treated, but the results are not as good. “All consensus and clinical practice guidelines recommend baseline screening for HBV,” Manzano-Alonso reported.
1. Manzano-Alonso ML et al, “Reactivation of hepatitis B virus infection after cytotoxic chemotherapy or immunosuppressive therapy”, World Journal of Gastroenterology 2011 March 28; 17(12): 1531. http://www.ncbi.nlm.nih.gov/pubmed/21472116
2. Hepatitis B. PubMed Health. Web. Sept. 30, 2011.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
Reviewed October 12, 2011
by Michele Blacksberg RN
Edited by Jody Smith