The Effects of Immunotherapy on Current or Past HBV Infection

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To evaluate the incidence of hepatitis flare, HBV reactivation, hepatitis B surface antigen (HBsAg) seroclearance or seroreversion in patients with current or past HBV infection who had received immunotherapy, evaluation was carried out. Immunotherapy had dramatically improved the survival of patients with advanced or metastatic malignancies, indicating this evaluation.

A territory-wide, observational cohort study was carried out in Hong Kong. Patients were identified through electronic medical records, based on the prescriptions of immune checkpoint inhibitors from July 1, 2014 to December 31, 2019.
Patients who were HBsAg-positive or HBsAgnegative with results for antibody to hepatitis B
surface or core antigen (anti-HBs or anti-HBc), were included.

A total of 990 patients (397 HBsAg-positive, 593 HBsAg-negative), with 482 anti-HBc and/ or anti-HBs positive and 111 both anti-HBC and anti-HBs negative) were identified. All of HBsAgpositive and 15.9% HBsAg-negative were put
on oral antiviral treatment. Hepatitis flare (ALT greater than 2 times the upper limits of normal), occurred in 39.3% HBsAg-positive and 30.4% HBsAg-negative patients. High baseline ALT and combination of immunotherapy increased the risk of hepatitis. HBV reactivation (greater than 2 logs increase in HBV DNA from baseline), occurred in 2 HBsAg-positive patients. HBsAg seroclearance and seroreversion was observed in 1 HBsAg-positive and 1 HBsAg-negative patient, respectively (less than 1%).

It was concluded that hepatitis flare occurs in possibly 40% of HBsAg-positive patients and 30% of HBsAg-negative patients during immunotherapy. HBV reactivation, HBsAg
seroclearance and HBsAg seroconversion are rare. It was also concluded that current or past HBV infection has no impact on the emergence of hepatitis flare associated with immunotherapy.

Wong, G., Wong, V., Wing, V., et al. “Hepatitis Flare During Immunotherapy in Patients with Current or Past Hepatitis B Virus Infection.” American Journal of Gastroenterology 2021; Vol. 116, pp. 1274-1283.

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