Risk of hepatitis B virus reactivation in HBsAg negative/anti-HBc positive patients with malignancies: a prospective study

Abstract

Abstract: Objective To prospectively evaluate the rate of hepatitis B virus reactivation (HBVr) in HBsAg negative/anti-HBc positive (HBsAg-/anti-HBc+) patients with malignancies, thus to assess the risk of HBVr more accurately and optimize the management in this special population.Methods HBsAg-/anti-HBc+ patients with malignant tumors admitted to the Department of Oncology in a tertiary hospital from June to July 2021 and received anti-tumor treatment were selected as the subjects. Demographic data, tumor type, anti-tumor regimen, HBV markers such as HBV RNA, HBV DNA, HBsAg and HBeAg were collected prospectively at baseline and 6 months of anti-tumor treatment. HBVr was confirmed if any of the HBV markers turned positive, and the incidence of HBVr was analyzed to evaluate the risk of HBVr in the HBsAg-/anti-HBc+ background.Results A total of 36 HBsAg-/anti-HBc+patients with malignancies were included, all of whom had baseline serum HBV DNA <10 IU/mL, HBV RNA <50 copies/mL, HBsAg and HBeAg negative. Anti-HBs was detectable in 24 cases (66.67%), with 9 patients (25.00%) had anti-HBs≥100 mIU/mL. There were 2 patients (5.56%) in high risk subgroup, 4 patients (11.11%) in moderate risk subgroup, 26 patients (72.22%) in low risk subgroup, and 4 patients (11.11%) in uncertain risk subgroup. After 6 months of anti-cancer treatment, the total incidence of HBVr was 8.33% (3/36). The rates of HBVr in the high, moderate, low and uncertain risk subgroups were 0% (0/2), 25% (1/4), 3.85% (1/26) and 25% (1/4), respectively. No significant difference in HBVr rates were seen between anti-HBs positive and negative subgroups (3/24 vs 0/12, P=0.54), or between anti-HBs≥100 mIU/mL and <100 mIU/mL subgroups (1/9 vs 2/27, P=1.00). The levels of HBV DNA by the end of 6 months in the three HBVr patients (with baseline anti-HBs and risk stratification of anti-tumor treatment) were 12.49 IU/mL (23.19 mIU/mL and moderate risk), 19.24 IU/mL (1.23 mIU/mL and low risk), and 71.55 IU/mL (145.58 mIU/mL and uncertain risk).Conclusion Tumor patients with baseline HBsAg-/anti-HBc+and both HBV RNA and HBV DNA below the lower limit of detection, even those with relatively higher baseline anti-HBs and low or uncertain risk of anti-tumor regimens, may be still at risk of HBV reactivation. The results strongly mean that careful assessment and prevention of HBVr should also be emphasized in these patients.

Key words: Anti-HBc positive, HBsAg negative, HBV DNA, HBV RNA, Malignant tumors, Hepatitis B virus reactivation

HAO Kun-yan, ZHANG Yi-qing, WANG Feng, ZHU Hao, WANG Wen-yang, SHEN Min, CHEN Xiao-hui, LI Ping, YU Yue-cheng. Risk of hepatitis B virus reactivation in HBsAg negative/anti-HBc positive patients with malignancies: a prospective study[J]. Chinese Hepatolgy, 2024, 29(12): 1464-1467.

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