Occult HBV infection in the oncohematological setting

Area of Science:

• Hepatology
• Oncology
• Virology

Background:

• Occult hepatitis B infection (OBI) is characterized by low Hepatitis B Virus (HBV) levels in HBsAg-negative individuals.
• OBI reactivation can occur in oncohematological patients during immunosuppressive therapy, ranging from increased HBV replication to severe liver necrosis.
• Reactivation poses risks, including hepatic failure and treatment discontinuation, necessitating prophylactic strategies.

Purpose of the Study:

• To review the clinical impact of OBI in oncohematological patients.
• To provide guidance on OBI prophylaxis for healthcare workers managing these patients.

Main Methods:

• This is a review article.
• Focuses on the clinical impact and management of OBI in the oncohematological setting.

Main Results:

• International guidelines recommend lamivudine prophylaxis for hematopoietic stem cell transplantation and with high-dose corticosteroids or specific monoclonal antibodies (anti-CD20, anti-CD52).
• For patients with advanced liver disease at high risk of OBI reactivation, entecavir or tenofovir are preferred over lamivudine.
• For less intensive therapies, monitoring is advised, with prompt initiation of entecavir or tenofovir upon OBI reactivation.

Conclusions:

• Prophylactic antiviral therapy is crucial for oncohematological patients at risk of OBI reactivation.
• Drug choice (lamivudine vs. entecavir/tenofovir) depends on the intensity of immunosuppression and patient's liver status.
• Close monitoring and early treatment are essential for managing OBI in this vulnerable population.