Clinical profile and efficacy of antivirals in Hepatitis B virus reactivation, in cancer patients receiving chemotherapy: A 3 year prospective study in a tertiary care center.

ABSTRACT Aims/Objectives Hepatitis B virus Reactivation(HBVR) is common in cancer patients. Aim of the present study was to find out clinical profile of cancer patients receiving chemotherapy with HBVR and to study the efficacy of entecavir and tenofovir in the treatment of HBVR. Material and Methods This is a prospective study in which all consecutive cancer patients with evidence of HBVR were included. HBVR was defined as: New onset transaminitis with ALT > 3 times upper limit of normal and >10 fold increase in HBV DNA levels from baseline levels or detection of HBV-DNA ≥100,000 IU/ml in patients with no baseline HBV DNA. Patients with HBVR were put on entecavir or tenofovir and were closely monitored for efficacy and safety for minimum of 1 year. Results Out of 204 HBsAg positive patients with different cancers, 92 met the inclusion criteria. Out of 92, 46 received entecavir(ETV) 0.5 mg/day and 46 received tenofovir disoprovil fumarate(TDF) 300 mg/day. At 6 months, there was 4.7 log reduction in HBV DNA level in ETV group and 5.2 log reduction in TDF group(p=0.029). Proportion of patients with undetectable HBV DNA(75.7% vs 87.5%), ALT normalization(89.2% Vs 87.5%), HBsAg negativity(25% vs 28.1%) and seroconversion (2.8 % vs 3.1 %) at 1 year were almost similar in both groups with p value >0.05 for all efficacy end points. There was no HBVR related mortality in any group. Conclusion Both entecavir and tenofovir are very effective in the treatment of HBVR and reduce the liver related mortality and morbidity in such patients.