Lamivudine
Prophylaxis in HBV Carriers Receiving Chemotherapy for Malignancies
Reactivation
of hepatitis B virus (HBV) is a well-recognized complication
of chemo/immunosuppressive therapy in individuals who
are HBV surface antigen-positive inactive carriers and in
individuals with chronic HBV infection.
Although
it is well established that chemo/immunosuppressive
therapy enhances HBV replication with a resultant
increase in the viral load and disease activation,
the role of prophylactic lamivudine
(Epivir-HBV) therapy to prevent
chemo/immunosuppressive therapy-induced HBV activation
in HBV-positive individuals who are to receive chemo/immunosuppressive
therapy remains controversial.
The
aims of the present article are:
(i) to
determine the effect of lamivudine prophylaxis in HBV
carriers with hemato-oncological malignancies who require
chemotherapy;
(ii) to
define the duration and safety of lamivudine in
such individuals; and
(iii) to
identify the effect of lamivudine prophylaxis
on the outcome of chemotherapy administered for the
primary disease.
The
data currently available suggest that lamivudine
prophylaxis prevents chemotherapy-induced HBV reactivation
in HBV carriers with hemato-oncological malignancies
who receive chemotherapy. Lamivudine is safe
and tolerable in such individuals.
The
duration of lamivudine prophylaxis is not yet known; however,
it would appear prudent to begin lamivudine at the
time of the initiation of the chemotherapy and
to continue it throughout the period of chemotherapy
administration and for at least 1 and possibly
2 years following the discontinuation of the chemotherapy.
Finally,
the prophylactic use of lamivudine in inactive HBV
carriers with hemato-oncological malignancy prevents
interruptions in their treatment for primary
disease as a result of HBV reactivation.
Department
of Gastroenterology, Ankara University School of Medicine,
Ankara, Turkey
07/25/05
Reference
R Idilman and others. Lamivudine prophylaxis in HBV carriers
with haemato-oncological malignancies who receive chemotherapy.
Journal
of Antimicrobial Chemotherapy 55(6): 828-831. June 2005.
