Management of Hepatitis-B Virus Infection in Immunocompromised Children: A Single Center Experience

被引:2
作者
Calvo, Pier Luigi [1 ]
Pinon, Michele [1 ]
Dell'Olio, Dominic [2 ]
Carpino, Andrea [3 ]
Biasin, Eleonora [4 ]
Pizzol, Antonio [1 ]
Catalano, Silvia [5 ]
Peruzzi, Licia [6 ]
Rigazio, Caterina [1 ]
Cisaro, Fabio [1 ]
Opramolla, Anna [1 ]
Asaftei, Sebastian Dorin [4 ]
Quarello, Paola [4 ]
Fagioli, Franca [4 ]
机构
[1] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Pediat Gastroenterol Unit, Piazza Polonia 94, I-10123 Turin, Italy
[2] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Reg Transplant Ctr, Turin, Italy
[3] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Dept Pediat, Turin, Italy
[4] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Pediat Oncohematol, Stem Cell Transplantat & Cell Therapy Div, Turin, Italy
[5] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Liver Transplantat Ctr, Gen Surg 2 U, Turin, Italy
[6] Azienda Osped Univ Citta Salute & Sci, Regina Margherita Childrens Hosp, Pediat Nephrol Unit, Turin, Italy
关键词
direct-acting antivirals; hepatitis B reactivation; hepatitis B virus; nucleos(t)ide analogues; prophylaxis; LAMIVUDINE TREATMENT; CONTROLLED-TRIAL; REACTIVATION; CHEMOTHERAPY; PREVENTION; ENTECAVIR; PLACEBO; ASSOCIATION; PROPHYLAXIS; THERAPY;
D O I
10.1097/MPG.0000000000003042
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objectives: The aims of the study was to expand the pediatric experience on hepatitis-B virus (HBV) reactivation, a known complication in patients with hematologic malignancies or on immunosuppression. Methods: Retrospective appraisal of HBV therapy/prophylaxis in immunocompromised children, studied from April 2006 to March 2020. Results: Eighteen HBV-positive patients, 5 girls, median age 11.1 (4.1--17.9) years were included. Seventeen of 18 were immunosuppressed at HBV-infection diagnosis. Seventeen were at high risk of reactivation, 1 at moderate risk. Five of 18 had acute hepatitis B as first infection or reactivation, 6 had HBeAg-positive infection, 1 an HBeAg-negative infection and 6 HBsAg-negative infection. Median follow-up was 2.7 (0.7--12.5) years. No HBV-related mortality was observed. Prophylaxis had to be repeated in 1. Lamivudine was used in 6/12 viremic patients and HBV-DNA negativization obtained in 2/6 (33%). Tenofovir-DF was used in 2/12 and entecavir in 4/12: 100% attained HBV-DNA negativization. Therapy had to be switched from tenofovir-DF to entecavir in 1 patient because of renal impairment. Virological breakthroughs were observed in 1 lamivudine-treated patient, leading to a hepatitis flare; 1 patient on entecavir had a hepatitis flare at immunoreconstitution. Mortality was 33% in the HBsAg-positive group. Seven prophylactic treatments were administered to 6 patients with HBsAg-negative infection: tenofovir-DF in 2 HBV-DNA-positive, lamivudine in 5 HBV-DNA-negative, without reverse HBsAg seroconversion, morbidity or mortality. Conclusions: There is a residual risk of acute hepatitis B in immunocompromised children, mortality rate was substantial, potentially related to the delays in commencing chemotherapy caused by liver dysfunction. Tenofovir-DF or entecavir are the drugs of choice for HBV treatment in immunocompromised children.
引用
收藏
页码:597 / 602
页数:6
相关论文
共 38 条
[1]  
[Anonymous], 2017, WHO |
[2]  
Chan HLY, 2007, ANTIVIR THER, V12, P345
[3]   A Comparison of Entecavir and Lamivudine for the Prophylaxis of Hepatitis B Virus Reactivation in Solid Tumor Patients Undergoing Systemic Cytotoxic Chemotherapy [J].
Chen, Wen-Chi ;
Cheng, Jin-Shiung ;
Chiang, Po-Hung ;
Tsay, Feng-Woei ;
Chan, Hoi-Hung ;
Chang, Hsueh-Wen ;
Yu, Hsien-Chung ;
Tsai, Wei-Lun ;
Lai, Kwok-Hung ;
Hsu, Ping-I .
PLOS ONE, 2015, 10 (06)
[4]   Tenofovir Alafenamide for the Treatment of Chronic Hepatitis B Monoinfection [J].
Childs-Kean, Lindsey M. ;
Egelund, Eric F. ;
Jourjy, Jacqueline .
PHARMACOTHERAPY, 2018, 38 (10) :1051-1057
[5]   Vaccination of solid organ transplant candidates and recipients: Guidelines from the American society of transplantation infectious diseases community of practice [J].
Danziger-Isakov, Lara ;
Kumar, Deepali .
CLINICAL TRANSPLANTATION, 2019, 33 (09)
[6]   Hepatitis B Virus Reactivation What Is the Issue, and How Should It Be Managed? [J].
Ekpanyapong, Sirina ;
Reddy, K. Rajender .
CLINICS IN LIVER DISEASE, 2020, 24 (03) :317-+
[7]   EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection [J].
Lampertico P. ;
Agarwal K. ;
Berg T. ;
Buti M. ;
Janssen H.L.A. ;
Papatheodoridis G. ;
Zoulim F. ;
Tacke F. .
JOURNAL OF HEPATOLOGY, 2017, 67 (02) :370-398
[8]   Long-Term Outcomes of Entecavir Monotherapy for Chronic Hepatitis B After Liver Transplantation: Results up to 8 Years [J].
Fung, James ;
Wong, Tiffany ;
Chok, Kenneth ;
Chan, Albert ;
Cheung, Tan-To ;
Dai, Jeff Wing-Chiu ;
Sin, Sui-ling ;
Ma, Ka-Wing ;
Ng, Kelvin ;
Ng, Kevin Tak-Pan ;
Seto, Wai-Kay ;
Lai, Ching-Lung ;
Yuen, Man-Fung ;
Lo, Chung-Mau .
HEPATOLOGY, 2017, 66 (04) :1036-1044
[9]   Recommendations for Screening, Monitoring, and Referral of Pediatric Chronic Hepatitis B [J].
Haber, Barbara A. ;
Block, Joan M. ;
Jonas, Maureen M. ;
Karpen, Saul J. ;
London, W. Thomas ;
McMahon, Brian J. ;
Murray, Karen F. ;
Narkewicz, Michael R. ;
Rosenthal, Philip ;
Schwarz, Kathleen B. .
PEDIATRICS, 2009, 124 (05) :E1007-E1013
[10]  
Huang H, 2014, JAMA-J AM MED ASSOC, V312, P2521, DOI 10.1001/jama.2014.15704