Screening and evaluation of chronic and occult Hepatitis B in chemo – radiotherapy patients with cancer


1 Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Radiotherapy, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Hematology, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Biology, Shahrekord Azad University, Shahrekord, Iran

5 Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Hepatitis B virus infection (HBV) and its complications is one of the most serious problems of the health system in many parts of the world. In the present study, we will assess chronic and occult HBV and isolated anti-Hepatitis B core antigen whose screening and evaluation is not routine in different populations.
Materials and Methods: This descriptive analytical study was conducted on 213 patients undergoing chemotherapy - radiotherapy referred to the hematology - oncology clinics of Isfahan, Iran in 2012. In order to determine the serum levels of hepatitis B surface antigen (HbSAg), Hepatitis B Antigen and Antibody (HBCAb), aspartate aminotransferase (AST), alanine transaminase (ALT) and Alkaline phosphatase (ALK.P), venous blood samples were obtained. If the HBCAb sample was positive, another sample of the serum was sent to the laboratory to perform polymerase chain reaction and to determine viral load.

Results: The mean age of the patients was 47.7 ± 9 years, with an age range of 27 -73 years; 98 (46%) and 115 (54%) cases were male and female, respectively, with mean age of 51.9 ± 8.3 and 44.1 ± 8.1 years, and there was no significant difference (P < 0.001). The mean level of liver enzymes including AST, ALT and ALK.P were 34.2 ± 36.02, 38.9 ± 47.1 and 252.1 ± 234.7, respectively. Two cases were HbSAg positive (0.9%) and six cases were HBCAb positive (2.8%) and HbSAg negative. Three cases had a high viral load at the rate of starting treatment among positive anti-HBC patients.
Conclusion: Because occult hepatitis is investigated less commonly in routine studies, it seems that screening and evaluating its prevalence is useful in the management of patients.


McMahon BJ. Epidemiology and natural history of hepatitis B. Semin Liver Dis 2005;25(Suppl 1):3-8.  Back to cited text no. 1
Arababadi MK, Nasiri Ahmadabadi B, Yousefi Daredor H, Kennedy D. Epidermiology of occult hepatitis B infection among thalassemic, hemophilia, and hemodialysis patients. Hepat Mon 2012;12:315-9.  Back to cited text no. 2
Fang Y, Shang QL, Liu JY, Li D, Xu WZ, Teng X, et al. Prevalence of occult hepatitis B virus infection among hepatopathy patient and healthy people in China. J Infect 2009;58:383-8.  Back to cited text no. 3
Perrillo RP. Acute flares in chronic hepatitis B: The natural and unnatural history of an immunologically mediated liver disease. Gastroenterology 2001;120:1009-22.  Back to cited text no. 4
Cheng JC, Liu MC, Tsai SY, Fang WT, Jer-Min Jian J, Sung JL. Unexpectedly frequent hepatitis B reactivation by chemoradiation in postgastrectomy patients. Cancer 2004;101:2126-33.  Back to cited text no. 5
Lau GK, Leung YH, Fong DY, Au WY, Kwong YL, Lie A, et al. High hepatitis B virus (HBV) DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic transplantation. Blood 2002;99:2324-30.  Back to cited text no. 6
Ji D, Cao J, Hong X, Li J, Wang J, Chen F, et al. Low incidence of hepatitis B virus reactivation during chemotherapy among diffuse large B-cell lymphoma patients who are HBsAg-negative/HBcAb-positive: A multi center retrospective study. Eur J Haematol 2010;85:243-50.  Back to cited text no. 7
Even AM, Jovanovic BC, Su YC, Raisch DW, Ganger D, Belknap SM, et al. Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoporoliferative disease: Meta-analysis and examination of FDA safety reports. Ann Oncol 2011;22:1170-80.  Back to cited text no. 8
Lok SF. Occult hepatitis B virus infection: Diagnosis, implication and management? J Gastroenteral Hepatol 2004;19:S114 -7.  Back to cited text no. 9
Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with hematological malignancies. Br J Haematol 2007;136:699-712.  Back to cited text no. 10
Cornberg M, Protzer U, Petersen J, Wedemeyer H, Berg T, Jilg W, et al. Prophylaxis, diagnosis and therapy of hepatitis B virus infection-the German guideline. Z Gastroenterol 2011;49:871-930.  Back to cited text no. 11
Ahmed A, Keeffe EB. Lamivudine therapy for chemotherapy-induced reactivation of hepatitis B virus infection. Am J Gastroenterol 1999;94:249-51.  Back to cited text no. 12
Eren OO, Artac M, Boruban MC, Yavas O, Arslan U, Basaranoglu M. Chemotherapy-induced Hepatitis B virus reactivation in HbsAg positive cancer patient: A single center experience. Med Oncol 2009;26:386-92.  Back to cited text no. 13
Kumar CH, Gupta LC, Jaiprakash BM. The role of anti-HBC IgM in screening of blood donors. Med J Arm Forc Ind 2007;63:350-2.  Back to cited text no. 14
Fontenele AM, Filho NS, Ferreira AS. Occult hepatitis B in patients on hemodialysis: A review. Ann Hepatol 2013;12:527-31.  Back to cited text no. 15
Arababadi MK, Poor Azar A, Salehi M, Jaafarzadeh A. Evaluation of occult hepatitis B virus infection in blood donor with negative HbSAg and positive anti HBC. Shahgid Sadoughi Journal of Yaz University of Medical Sciences 2007;1:74.[Persian]  Back to cited text no. 16
Alavian SM, Miri SM, Hollinger FB, Jazayeri SM. Occult hepatitis B (OBH) in clinical settings. Hepat Mon 2012;12:e6126.  Back to cited text no. 17