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02 Mar 2015

Patients undergoing life-saving organ transplants and cancer therapy are at risk of a potentially fatal flare-up of pre-existing hepatitis B infections, researchers from the Saint Louis University in Missouri have found.

Patients previously infected with the hepatitis B virus (HBV) who undergo treatments that suppress the immune system, including those for cancer, auto-immune disease and transplantation, may be at risk of reactivating the disease, with possibly deadly consequences, the researchers warned.

HBV is transmitted by contact with body fluids, such as blood from an infected individual, causing acute or chronic disease that attacks the liver. While vaccination helps slow the spread of the virus, it is estimated as much as 10 per cent of the global population is infected with chronic HBV.

The American Food and Drug Administration (FDA) issued a boxed warning in September 2013 for two medications that target protein CD20, which is found on immune system B cells, which may reactivate HBV. The regulator urged doctors to screen patients for HBV before using the drugs.

But Saint Louis University researchers have warned the FDA warning might just be the tip of the iceberg.

“Reactivation of HBV is a potentially lethal condition and yet is preventable,” Dr Adrian Di Bisceglie said. “Our research suggests that the issue of HBV reactivation may be an under-appreciated clinical challenge that extends well beyond the use of just two anti-CD20 medications.”

Dr Di Bisceglie said all patients undergoing chemotherapy, immunosuppressive therapy, hematopoietic stem cell transplantation, or solid organ transplantation should be screened for active or prior HBV infection.

 “While further study will be necessary to completely define the risks, benefits and costs of universal screening, we feel that the evidence as it stands now is sufficiently compelling to make routine screening for hepatitis B a standard practice,” he said.

 

Kirsty Waterford


Published: 02 Mar 2015