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Blood, 15 July 2002, Vol. 100, No. 2, pp. 391-396
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Lamivudine therapy for prevention of immunosuppressive-induced
hepatitis B virus reactivation in hepatitis B surface antigen
carriers
Oren Shibolet,
Yaron Ilan,
Shmuel Gillis,
Ayala Hubert,
Daniel Shouval, and
Rifaat Safadi
From the Liver Unit, Division of Medicine; the
Department of Hematology; and the Department of Oncology; Hadassah
University Hospital, Jerusalem, Israel.
Viral reactivation in hepatitis B surface antigen (HBsAg)
carriers undergoing immunosuppressive therapy is well documented. To
evaluate the role of lamivudine prophylaxis in Hepatitis B virus (HBV)
carriers treated with immunosuppression for nonhepatic disorders, we
reviewed our experience between 1997 and 2000 at Hadassah University
Hospital (Jerusalem, Israel). Controls were patients who were HBV
carriers and who, between 1990 and 1995, were treated for hematological
malignancies but were not treated with lamivudine. Eighteen
HBsAg-positive patients were treated with immunosuppression. Fourteen
were males, with a mean age of 48 years. Eleven patients had lymphoma;
2 had colonic adenocarcinoma; and 5 had cryoglobulinemia,
enophthalmitis, vasculitis, malignant histocytosis, or
ulcerative colitis. Fourteen patients were treated with chemotherapy,
and 4 with prolonged high-dose corticosteroids. All patients were
HBsAg-positive; 4 had hepatitis B e antigen, and 10 had HBV DNA by polymerase chain reaction. Lamivudine was administered
to 13 patients in the treatment group 1 to 60 days (mean, 15 days)
before immunosuppressive treatment and continued 0.5 to 24 months
(mean, 7 months) following initiation of immunosuppression. Mean
follow-up after lamivudine administration was 21 months. Three patients
died of lymphoma complications and 10 (77%) survived. None of the
patients had clinical or serological evidence of HBV reactivation
during or after lamivudine prophylaxis. Of 6 patients who presented
with liver function test disturbances, 5 improved during combined
lamivudine and immunosuppression treatment. At the end of follow-up,
HBV DNA became undetectable in 2 of 10 patients. In 2 patients,
seroconversion from HBsAg to anti-HBs was observed. In contrast, 2 of 5 control patients had HBV reactivation. Lamivudine prophylaxis in HBsAg
carriers receiving immunosuppressive therapy may prevent HBV
reactivation and hepatic failure.
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