Anti-viral prophylaxis in inactive hepatitis B virus carriers with hemato-oncological malignancies who receive chemotherapy.

Hepatitis B virus reactivation-related hepatitis is a serious cause of liver-related morbidity and mortality in inactive hepatitis B virus carriers with hemato/oncological malignancies who receive chemo/immunosuppressive therapy. It occurs in 14% to 50% of such individuals and the mortality ranges from 3.7% to 60%. The aims of the present review were 1) to determine the effect of lamivudine prophylaxis in inactive hepatitis B virus carriers with hemato/oncological malignancies who receive chemo/immunosuppressive therapy, and 2) to define the safety and duration of lamivudine in such individuals. The data currently available suggest that all individuals with hemato/oncological malignancies who undergo chemo/immunosuppressive therapy should be screened for hepatotropic viruses. Lamivudine prophylaxis in inactive hepatitis B virus carriers with hemato/oncological malignancies who receive chemo/immunosuppressive therapy prevents chemo/immunosuppressive-induced hepatitis B virus reactivation. Lamivudine also prevents interruptions in treatment as a result of hepatitis B virus reactivation. Lamivudine is safe and tolerable in such individuals. The ideal protocol of lamivudine prophylaxis for the prevention of hepatitis B virus reactivation in such individuals is not yet established. However, it would appear prudent to begin lamivudine at the time of the initiation of the chemo/immunosuppressive therapy and to continue it throughout the period of chemo/immunosuppressive administration and for at least one but possibly two years following the therapy discontinuation.