Prevalence and chemotherapy-induced reactivation of occult hepatitis B virus among hepatitis B surface antigen negative patients with diffuse large B-cell lymphoma: Significance of hepatitis B core antibodies screening

Background: occult hepatitis b infection (obi) is characterized by negative hepatitis b surface antigen (hbsag) and detectable hepatitis b virus (hbv)-dna in the liver and/or serum,with or without hepatitis b core antibody (anti-hbc). anti-hbc is the most sensitive marker of previous hbv. hbv reactivation in patients under immunosuppressive treatment is life-threatening,occurring in both overt and occult hbv especially in hematological malignancies. aim of the work: to evaluate the prevalence and chemotherapy-induced reactivation of obi among hepatitis b surface antigen negative patients with diffuse large b-cell lymphoma (dlbcl) patients and to determine the significance of anti-hbc screening among this group of patients before receiving chemotherapy. patients and methods: this cross-sectional study included 72 dlbcl patients negative for hbsag,hbsab and hepatitis c virus antibodies (anti-hcv). patients were subjected to investigations including anti-hbc. all patients underwent alanine transaminase (alt) monitoring before each cycle of chemotherapy and monthly for 12. months after the end of chemotherapy. patients with suspected obi were tested for hbv-dna using real-time polymerase chain reaction (pcr). results: anti-hbc was detected in 10 of 72 hbsag negative sera (13.89%) (95% confidence interval 6.9-22.2%). five of the 10 anti-hbc positive patients in this study had obi reactivation. conclusion: the study concluded that anti-hbc screening is mandatory before chemotherapy. hbsag-negative/anti-hbc-positive patients should be closely observed for signs of hbv reactivation through the regular monitoring of alt. prophylaxis lamivudine is recommended for anti-hbc positive patients before chemotherapy. © 2015 production and hosting by elsevier b.v.