A snapshot of virological presentation and outcome of immunosuppression-driven HBV reactivation from real clinical practice: Evidence of a relevant risk of death and evolution from silent to chronic infection
| Autor: | Romina Salpini, Arianna Battisti, Luna Colagrossi, Domenico Di Carlo, Lavinia Fabeni, Lorenzo Piermatteo, Carlotta Cerva, Miriam Lichtner, Claudio Mastroianni, Massimo Marignani, Sarah Maylin, Constance Delaugerre, Filomena Morisco, Nicola Coppola, Aldo Marrone, Mario Angelico, Loredana Sarmati, Massimo Andreoni, Carlo‐Federico Perno, Francesca Ceccherini‐Silberstein, Valentina Svicher, Ada Bertoli, Vanessa Fini, Michela Pollicita, Gaetano Maffongelli, Alessandra Ricciardi, Cesare Sarrecchia, Leonardo Baiocchi, Arianna Brega, null Daniele Di Paolo, Simona Francioso, Ilaria Lenci, William Arcese, Laura Cudillo, Benedetta Mariotti, null Claudio Miriam Lichtner, Raffaella Marocco, Maria Mastroianni, Gloria Taliani, Tiziana Tieghi, Maria Rosaria Esposito, Terenzio Mari, Ettore Mazzoni, Fabrizio Spaziani, Katia Casinelli, Maurizio Paoloni, Nerio Iapadre, Alessandro Grimaldi, Paola Begini, Barbara Imperatrice, Luigi Vanvitelli, Margherita Macera, Mariantonietta Pisaturo, Chiara more, Isabella Siniscalchi |
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| Přispěvatelé: | Salpini, R, Battisti, A, Colagrossi, L, Di Carlo, D, Fabeni, L, Piermatteo, L, Cerva, C, Lichtner, M, Mastroianni, C, Marignani, M, Maylin, S, Delaugerre, C, Morisco, F, Coppola, N, Marrone, A, Angelico, M, Sarmati, L, Andreoni, M, Perno, Cf, Ceccherini-Silberstein, F, Svicher, V, Salpini, R., Battisti, A., Colagrossi, L., Di Carlo, D., Fabeni, L., Piermatteo, L., Cerva, C., Lichtner, M., Mastroianni, C., Marignani, M., Maylin, S., Delaugerre, C., Morisco, F., Coppola, N., Marrone, A., Angelico, M., Sarmati, L., Andreoni, M., Perno, C. -F., Ceccherini-Silberstein, F., Svicher, V. |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Hepatitis B virus HBsAg medicine.medical_specialty Genotype Settore MED/17 - Malattie Infettive medicine.medical_treatment Treatment outcome Hbv reactivation HBV reactivation Immunocompromised Host 03 medical and health sciences Hepatitis B Chronic HBV chronicity Immunosuppression antiviral prophylaxis 0302 clinical medicine Virology Internal medicine Humans Medicine 030212 general & internal medicine Hepatitis B Surface Antigens Hepatology business.industry Genetic Variation virus diseases Viral Load Hepatitis B digestive system diseases Clinical Practice Chronic infection Treatment Outcome Infectious Diseases Disease Progression Female Virus Activation 030211 gastroenterology & hepatology Rituximab antiviral prophylaxi Risk of death business hbv chronicity hbv reactivation immunosuppression Immunosuppressive Agents medicine.drug |
| Popis: | The study was undertaken in order to provide a snapshot from real clinical practice of virological presentation and outcome of patients developing immunosuppression-driven HBV reactivation. Seventy patients with HBV reactivation were included (66.2% treated with rituximab, 10% with corticosteroids and 23.8% with other immunosuppressive drugs). Following HBV reactivation, patients received anti-HBV treatment for a median (IQR) follow-up of 31(13-47) months. At baseline-screening, 72.9% of patients were HBsAg-negative and 27.1% HBsAg-positive. About 71.4% had a diagnosis of biochemical reactivation [median (IQR) HBV DNA and ALT: 6.9 (5.4-7.8) log IU/mL and 359 (102-775) U/L]. Moreover, 10% of patients died from hepatic failure. Antiviral prophylaxis was documented in 57.9% and 15.7% of HBsAg-positive and HBsAg-negative patients at baseline-screening (median [IQR] prophylaxis duration: 24[15-33] and 25[17-36] months, respectively). Notably, HBV reactivation occurred 2-24 months after completing the recommended course of anti-HBV prophylaxis in 35.3% of patients. By analysing treatment outcome, the cumulative probability of ALT normalization and of virological suppression was 97% and 69%, respectively. Nevertheless, in patients negative to HBsAg at baseline-screening, only 27% returned to HBsAg-negative status during prolonged follow-up, suggesting the establishment of chronic infection. In conclusion, most patients received a diagnosis of HBV reactivation accompanied by high ALT and 10% died for hepatic failure, supporting the importance of strict monitoring for an early HBV reactivation diagnosis. Furthermore, HBV reactivation correlates with high risk of HBV chronicity in patients negative for HBsAg at baseline-screening, converting a silent into a chronic infection, requiring long-term antiviral treatment. Finally, a relevant proportion of patients experienced HBV reactivation after completing the recommended course of anti-HBV prophylaxis, suggesting the need to reconsider proper duration of prophylaxis particularly in profound immunosuppression. |
| Databáze: | OpenAIRE |
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