Liu Chun-Jen, Chen Pei-Jer, Chen Ding-Shinn, Kao Jia-Horng
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te St, Taipei, 10002, Taiwan.
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
Hepatol Int. 2013 Jun;7(2):316-26. doi: 10.1007/s12072-011-9279-6. Epub 2011 Jun 14.
Chronic hepatitis B virus (HBV) infection is endemic in the Asian-Pacific region, and reactivation of HBV post-cancer chemotherapy has become an emerging clinical challenge. Patients with detectable serum HBV DNA before chemotherapy and those receiving intensive chemotherapy are particularly at a risk of HBV reactivation. Most patients with HBV reactivation are positive for hepatitis B surface antigen (HBsAg) and are, therefore, easily identified by recommended serological screening before chemotherapy. However, a small, but significant proportion of subjects who have apparently recovered from HBV infection as reflected by HBsAg negativity and hepatitis B core antibody positivity in HBV endemic areas may also experience reactivation when host immunity is severely compromised by cancer chemotherapy. Serum alanine aminotransferase, HBsAg, and/or HBV DNA should be monitored closely in these subjects and antiviral therapy should be administered immediately when any evidence of HBV reactivation is detected during chemotherapy. The prophylactic use of nucleos(t)ide analogs before chemotherapy and its continuation until reconstitution of host immunity remain the mainstay of effective prevention of hepatitis B reactivation in this special clinical entity.
慢性乙型肝炎病毒（HBV）感染在亚太地区呈地方性流行，癌症化疗后HBV再激活已成为一个新出现的临床挑战。化疗前血清HBV DNA可检测到的患者以及接受强化化疗的患者尤其有HBV再激活的风险。大多数HBV再激活患者的乙型肝炎表面抗原（HBsAg）呈阳性，因此，通过化疗前推荐的血清学筛查很容易识别。然而，在HBV流行地区，一小部分但比例可观的受试者，其HBsAg阴性和乙型肝炎核心抗体阳性表明他们显然已从HBV感染中康复，但当宿主免疫因癌症化疗而严重受损时，也可能发生再激活。应对这些受试者密切监测血清丙氨酸氨基转移酶、HBsAg和/或HBV DNA，并且在化疗期间检测到任何HBV再激活证据时应立即给予抗病毒治疗。化疗前预防性使用核苷（酸）类似物并持续至宿主免疫重建，仍然是有效预防这一特殊临床情况中乙型肝炎再激活的主要手段。
