乙型肝炎病毒再激活(HBVr)是癌症化療過程中的嚴重並發症。然而，乙肝病毒篩查的利用不足和抗病毒藥物預防治療不充分利用已屢有報道。
作者為了在癌症化療期間捕獲與HBVr相關的經驗，以電子版形式向美國肝病研究協會的成員分發帶有30個問題的問卷。調查問卷詳細規定了診斷標準，並收集關於乙肝病毒篩查，抗病毒藥物預防和臨床結果的信息。99名受訪者報導有188例患者符合HBV再激活的診斷標準。41名受訪者是在美國以外的地方工作，大多數是肝病學者(N = 71)或胃腸病學者(N = 12)。120例患者患有血液係統惡性腫瘤，其中88例患者(70%)有淋巴瘤。75例患者(40%)有乙型肝炎表麵抗原(HBsAg)和乙型肝炎核心抗原抗體(抗-HBc)，另外24例患者(13%)隻有HBsAg。預防性抗病毒療法僅在18例患者(10%)中被報道使用。52例(41%)患有血液學惡性腫瘤的患者和41例患有實體瘤的患者中有26(63%)例患者(p = 0.01)的化療被中斷。利妥昔單抗治療的患者(n = 66)需要更頻繁的住院治療(P = 0.04)，但他們的總生存率和不使用利妥昔單抗治療的個體並沒有差異。整體上因肝功能衰竭造成死亡的病例數有43例(23%)。預防性抗病毒治療一般都是應用在那些癌症化療開始之前就感染乙肝病毒的大部分患者中。這種情況的原因還需要進一步的探索，因為再激活會導致嚴重不良結果，然而這些是可以預防的。
醫學論壇網編譯自：Hepatitis B Reactivation During Cancer Chemotherapy，J Viral Hepat.2015;22(3):346-352.
文獻原文：
Abstract
Hepatitis B virus reactivation (HBVr) can be a serious complication of cancer chemotherapy. However, underutilization of HBV screening and secondary underutilization of antiviral prophylaxis have been frequently reported. The authors electronically distributed a 30-point questionnaire to members of the American Association for the Study of Liver Diseases to capture experiences with HBVr during cancer chemotherapy. The questionnaire specified diagnostic criteria and collected information on HBV screening, antiviral prophylaxis and clinical outcomes. Ninety-nine respondents reported 188 patients who met the criteria for HBV reactivation. Forty-one practised outside the United States, and most were hepatologists (n = 71) or gastroenterologists (n = 12). One hundred and twenty-six patients had haematologic malignancies, of which 88 (70%) had lymphoma. Seventy-five patients (40%) had screening for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc), and an additional 24 patients (13%) had HBsAg screening alone. Prophylactic antiviral therapy was reported in only 18 patients (10%). Chemotherapy was interrupted in 52 patients (41%) with haematologic malignancies and 26 of 41 patients (63%) with solid tumours (P = 0.01). Rituximab-treated patients (n = 66) required hospitalization more frequently (P = 0.04), but their overall survival did not differ from individuals not treated with rituximab. Death due to liver failure was reported in 43 patients overall (23%). Underutilization of prophylactic antiviral therapy occured in a substantial number of patients who were found to be HBV infected prior to the initiation of cancer chemotherapy. The reasons for this need further exploration because reactivation results in serious yet preventable outcomes.
