HBV Reactivation During Immunotherapy Examined

While undergoing immunotherapy, hepatitis flare occurred in almost 40% of patients who had tested positive for current hepatitis B infection and 30% of those who tested negative, according to a study published in The American Journal of Gastroenterology.

“Immunotherapy has dramatically improved the survival of patients with advanced or metastatic malignancies,” researchers wrote in the study introduction. “Recent studies suggest that immunotherapy may increase the risk of hepatitis, whereas it may also induce functional cure of chronic hepatitis B virus infection.”

The observational cohort study took place in Hong Kong and included 990 patients taking immune checkpoint inhibitors. Among them, 397 were positive for hepatitis B surface antigen (HBsAg), and 593 were HBsAg-negative. Among those who were HBsAg-negative, 482 were positive for antibody to hepatitis B surface or core antigen (anti-HBs or anti-HBc), and 111 were negative for anti-HBs or anti-HBc.

All HBsAg-positive patients, and 15.9% HBsAg-negative patients, were on oral antiviral treatment.

Hepatitis flare, or alanine aminotransferase greater than 2 times the upper limit of normal, occurred in 39.3% of patients who were HBsAg-positive, according to the study, and 30.4% of patients who were HBsAg-negative. Hepatitis risk was heightened in patients with high alanine aminotransferase at baseline and who received a mix of immunotherapy.

Two patients who were HBsAg-positive experienced hepatitis B reactivation, the study found. One patient who was HBsAg-positive experienced HBsAg seroclearance, and one patient who was HBsAg-negative experienced seroreversion.

“Hepatitis B reactivation, HBsAg seroclearance, and HBsAg seroreversion are rare,” researchers concluded. “Current or past hepatitis B infection has no impact on the emergence of hepatic flare associated with immunotherapy.”

—Jolynn Tumolo

Reference

Wong GL, Wong VW, Hui VW, et al. Hepatitis flare during immunotherapy in patients with current or past hepatitis B virus infection. Am J Gastroenterol. 2021;116(6):1274-1283.