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Regular HBV DNA monitoring during immunosuppression cost-effective

Regular monitoring of hepatitis B DNA during immunosuppression therapy in patients with occult HBV demonstrated a clear cut-off between those who were more likely to progress to active HBV and those who avoided reactivation, according to a recently published study.

“Biweekly monitoring of liver biochemistry and serum [HBV surface antigen] is inexpensive, has a short turnaround time, and can be a management option in resource-restrained regions that are endemic for HBV,” Wai-Kay Seto, MD, from the University of Hong Kong, and colleagues wrote.

To evaluate the efficacy of a simple monitoring strategy, the researchers recruited 83 patients who were HBsAg-negative and anti-HBV core antigen-positive with newly diagnosed lymphoid malignancies being treated with a regimen of anti-CD20 monoclonal antibody.

During a median follow-up of 68 weeks, 16 patients developed HBV reactivation within 12 weeks to 60 weeks for a 2-year cumulative rate of 25%. All patients were HBsAg-negative at the time of reactivation.

The researchers found that patients with HBV DNA of 2,000 IU/mL or higher during biweekly monitoring were significantly more likely to develop HBV (P = .001) compared with those with lower HBV DNA levels.

“Our strategy of biweekly monitoring of liver biochemistry and HBsAg serology, together with the prompt administration of antiviral therapy upon the development of active HBV infection, effectively prevented the occurrence of HBV-related severe hepatitis,” the researchers wrote. “With less frequent monitoring intervals, severe hepatitis ... could occur.” – by Talitha Bennett

Disclosure: Seto reports being an advisory board member of Gilead Sciences and Bristol-Myers Squibb and received speaker’s fees from AbbVie, Gilead Sciences and Bristol-Myers Squibb. Please see the full study for the other authors’ relevant financial disclosures.