Hep B core-related antigen tied to higher reactivation risk during immunosuppression

Last Updated: 2016-09-30

By Reuters Staff

NEW YORK (Reuters Health) - Hepatitis B core-related antigen (HBcrAg) seropositivity is associated with an increased risk of hepatitis B virus (HBV) reactivation during high-risk immunosuppressive therapy, researchers from Hong Kong report.

Reactivation rates among occult HBV carriers undergoing immunosuppressive therapy can exceed 40%, the team notes in The American Journal of Gastroenterology, online September 20. Identification of these carriers could narrow the patient population requiring intensive monitoring during immunosuppressive treatment. More than 20% of chronic HBV infection patients have detectable serum HBcrAg after HBsAg clearance.

For the study, Dr. Man-Fung Yuen and colleagues from The University of Hong Kong, Queen Mary Hospital followed 124 HBsAg-negative, anti-HBc-positive individuals undergoing rituximab-containing chemotherapy and allogeneic hematopoietic stem cell transplantation.

At baseline, 22 patients (17.8%) were serum HBcrAg positive, and an additional 21 became HBcrAg positive during follow-up.

The two-year cumulative rate of HBV reactivation was 40.4%.

Twelve of the patients who were HBcrAg positive at baseline (54.5%) developed HBV reactivation, as did seven of the patients who became HBcrAg positive later (33.3%).

Most of the patients with documented HBcrAg positivity who did not develop HBV reactivation (19/24, 79.2%) were only transiently positive.

On multivariate analysis, baseline HBcrAg positivity was independently associated with a 2.94-fold increased risk of HBV reactivation.

Anti-HBs negativity was also independently associated with a 2.34-fold increased risk of HBV reactivation.

These increased risks were confined to the rituximab subgroup.

Serum HBcrAg positivity at one or more time points was associated with a significantly higher HBV reactivation rate (63.4%) than persistent HBcrAg negativity (24.2%).

"Serum HBcrAg may be potentially used to optimize monitoring strategies and identify patients who would most benefit from prophylactic antiviral treatment," the researchers conclude.

Dr. Yuen did not respond to a request for comments.

SOURCE: http://bit.ly/2df40ec

Am J Gastroenterol 2016.