Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara", Second University of Naples, 80131, Naples, Italy.
Azienda Ospedaliera Universitaria-Second University of Naples, 80131, Naples, Italy.
Infection. 2016 Oct;44(5):575-82. doi: 10.1007/s15010-016-0891-1. Epub 2016 Apr 13.
Occult hepatitis B infection (OBI), a virological condition characterized by a low release of Hepatitis B Virus (HBV) from liver cells and low HBV-DNA levels in serum and/or liver tissue of HBsAg-negative subjects, may reactivate in oncohematological patients undergoing immunosuppression by aggressive chemotherapy or hematopoietic stem cell transplantation. The entity of OBI reactivation varies from an increase in HBV replication without liver damage to an active HBV replication followed by liver cell necrosis, frequently severe and in some cases life threatening. Because of a possible severe outcome associated with OBI reactivation (hepatic failure or death due to the discontinuation of chemotherapy), prophylaxis with anti-HBV nucleot(s)ide analogues is recommended in relation to the foreseeable degree of immunosuppression.
This review article focuses on the clinical impact of OBI in the oncohematological setting and is addressed to all health care workers having in care oncohematological patients or involved in the treatment of HBV infection and OBI prophylaxis.
International guidelines have indicated lamivudine prophylaxis in hematopoietic stem cell transplantation and when high-dose corticosteroids or anti-CD20 or anti-CD52 monoclonal antibodies are used. Entecavir or tenofovir should replace lamivudine for patients with advanced liver diseases for whom reactivation of OBI may be life threatening. When anti-CD20 or anti-CD52 sparing schedules or other non-aggressive chemotherapies are used, monitoring may be indicated, but very early treatment with highly effective antiviral drugs (entecavir or tenofovir) should be administered once a reactivation of OBI has occurred.
隐匿性乙型肝炎病毒感染（OBI）是一种病毒学状态，其特征为乙型肝炎病毒（HBV）从肝细胞中低水平释放，以及 HBsAg 阴性患者血清和/或肝组织中 HBV-DNA 水平低。在接受强化化疗或造血干细胞移植的免疫抑制性抗肿瘤血液病患者中，可能会出现 OBI 再激活。OBI 再激活的程度各异，从 HBV 复制增加而无肝损伤，到 HBV 复制活跃继而肝细胞坏死，通常较为严重，在某些情况下甚至危及生命。由于 OBI 再激活可能导致严重后果（因化疗中断而导致肝衰竭或死亡），因此建议根据可预见的免疫抑制程度，用抗乙型肝炎核苷（酸）类似物进行预防。
本文重点讨论了 OBI 在肿瘤血液病环境中的临床影响，面向所有负责肿瘤血液病患者的医护人员，以及涉及乙型肝炎病毒感染和 OBI 预防的医护人员。
国际指南建议在造血干细胞移植时，以及在使用大剂量皮质类固醇、抗 CD20 或抗 CD52 单克隆抗体时，进行拉米夫定预防。对于因 OBI 再激活而可能危及生命的晚期肝病患者，应使用恩替卡韦或替诺福韦代替拉米夫定。对于使用抗 CD20 或抗 CD52 节省方案或其他非强化化疗的患者，可能需要监测，但一旦发生 OBI 再激活，应立即使用高效抗病毒药物（恩替卡韦或替诺福韦）进行早期治疗。
