Reactivation of Hepatitis B Virus in Breast Cancer Patients on Chemotherapy

Introduction and aim:Hepatitis B virus(HBV)infection is a worldwide disease associated with significant morbidity and mortality and after acute infection,HBV infection can persist in about1-2%of immunocompetent hosts.Breast cancer(BC)is a rapidly increasing problem in many developing countries,and cytotoxic chemotherapy is now an integral part of its management.HBV reactivation is wellrecognized in patients with hematological malignancies,but limited data are available on patientswith other,more common,cancers,such as BC.Methods:In these prospective studies,BC patients who were hepatitis-B-surface-antigen(HBsAg)seropositive were followed up during chemotherapy.The main objectives were to determine the incidence of HBVreactivation in BC patients undergoing conventional chemotherapy;to investigatewhether‘‘serial HBV-DNA monitoring’’improvesthe accuracy of diagnosing HBV reactivationwhen compared with previous schema thatonly measured HBV DNA at the time of clinicalhepatitis(‘conventional monitoring’);and toassess the clinical consequences as a result ofdeveloping the condition.Results:24%of patients developed HBV reactivation by conventional monitoring criteria,butwith serial HBV DNA monitoring,17%additional patients were diagnosed when increasedHBV-DNA-levels were detected before,but notconcomitant with,clinicalhepatitis.Thus,a total41%of patients developed HBV reactivation.Premature termination of chemotherapy or delayin treatment schedules occurred in71%of thepatients who developed viral reactivation,ascompared with 33% in those who did not developthe condition(P=0.019).Conclusion:The present studies highlights the importance of monitoringHBsAg-seropositive patients who are receivingchemotherapy for common solid tumors suchas BC.