Preventing severe chemotherapy-induced reactivation of hepatitis B - Time to adopt a universal approach

Chemotherapy induced reactivation of hepatitis B occurs in 40 - 50 of HBV infected people and mortality rates as high as 80 have been reported from the resulting decompensated liver disease. In 2012 such outcomes are almost entirely preventable and should be an unpleasant memory instead of an ongoing clinical concern. Potent immunosuppression is associated with increased HBV replication. Restoration of the immune response may lead to inflammatory liver disease and extensive hepatocyte death clinically manifested as severe acute hepatitis and, in some cases, hepatic decompensation and death. Severe hepatitis may impair a previously high-functioning patient and delay further chemotherapy allowing progression of the underlying malignancy. Importantly some patients with very severe disease may not respond to antiviral therapy. Numerous studies have documented the significant risk of HBV reactivation following the use of rituximab, a monoclonal antibody against CD20+ B cells, used common