Paul, S., Saxena, A., Terrin, N., Viveiros, K., Balk, E.M., & Wong, J.B. (2016). Hepatitis B virus reactivation and prophylaxis during solid tumor chemotherapy: A systematic review and meta-analysis. Annals of Internal Medicine, 164, 30–40.
STUDY PURPOSE: To determine the risk of hepatitis B virus (HBV) reactivation with or without antiviral prophylaxis, and the effectiveness of prophylaxis
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Risk for HBV reactivation without prophylaxis ranged from 4%–68% (median = 25%) and with prophylaxis ranged from 0.9%–31.4% (median = 4.1%). Among 13 studies comparing reactivation risk between patients who did and did not receive HBV prophylaxis, the pooled odds ratio [OR] was 0.12 (95% confidence interval [CI] [0.06, 0.22]).
HBV prophylaxis can help reduce the odds of HBV reactivation in patients with solid tumors undergoing chemotherapy.
HBV prophylaxis may reduce the chance of patients with a history of HBV experiencing reactivation when undergoing chemotherapy for solid tumors. The authors of this article noted that guidelines regarding HBV screening vary. While the American Society of Clinical Oncology (ASCO) recommends screening for individuals at high risk, the Centers for Disease Control and Prevention (CDC) and others recommend screening all patients receiving immunosuppressive therapy. The findings here provide some support for broad HBV screening and the appropriate use of HBV prophylaxis; however, this analysis had multiple limitations. Further study is warranted to determine the screening, prophylaxis, and cost-effectiveness benefits of these actions.