Persistent risk of HBV reactivation despite extensive lamivudine prophylaxis in haematopoietic stem cell transplant recipients who are anti-HBc-positive or HBV-negative recipients with an anti-HBc-positive donor
Persistent risk of HBV reactivation despite extensive lamivudine prophylaxis in haematopoietic stem cell transplant recipients who are anti-HBc-positive or HBV-negative recipients with an anti-HBc-positive donor
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DOI：
10.1016/j.cmi.2016.07.021
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发表时间：
2016-11-01
影响因子：
14.2
通讯作者：
Sarmati, L.
中科院分区：
文献类型：
--
作者：
Cerva, C.;Colagrossi, L.;Sarmati, L.
在373例接受拉米夫定（LMV）治疗的血液干细胞移植（HSCT）患者中评估了B型肝炎病毒（HBV）再激活的总体发生率，这些患者是抗-HBc阳性/HBV-DNA阴性受者，还是HBV阴性受者和抗-HBc阳性供者。根据HBV血清状态分层，计算两组自体（auto）或同种异体（allo）HSCT患者的HBV再激活发生率。前一组57例，其中抗-HBc阳性者10例，抗-HBc阳性者27例，非活动性携带者2例，抗-HBc阳性者3例，抗-HBc阳性者15例。该组中47例（82.4%）患者接受了LMV预防（LMV治疗的中位数（四分位距，IQR）为30（200-38）个月）。第二组包括320例抗-HBc阴性的自体HSCT和allo-HSCT受者和抗-HBc阴性的供体。这些患者均未接受任何预防治疗。第一组和第二组分别有2例患者发生HBV感染再激活，发生率分别为3.5%（95% CI 0.4-12.1%）和0.6%（95% CI 0.1-2.2%）。只有四分之一的患者接受了LMV治疗。HSCT后6年HBV再激活的累积概率为15.8%（95% CI 15.2-16.4%）。从HBV再激活患者中获得的四种病毒分离株中有三种在免疫活性HBsAg区域中存在突变。在仔细评估HBV预防的HSCT人群中，未接受LMV治疗的患者组中HBV再激活的风险持续存在。只有一个LMV治疗的患者经历了再激活的HBV与耐药HBV分离。C. Cerva，CMI 2016;22：946.e1-946.e8（C）2016欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
The overall rate of hepatitis B virus (HBV) reactivation was evaluated in a population of 373 haematological stem cell transplant (HSCT) patients treated with lamivudine (LMV) if they were anti-HBcpositive/HBV-DNA-negative recipients or if they were HBV-negative recipients with an anti-HBc-positive donor. The incidence of HBV reactivation was calculated in two groups of autologous (auto) or allogeneic (allo) HSCT patients who were stratified according to their HBV serostatus. The former group included 57 cases: 10 auto-HSCT and 27 allo-HSCT anti-HBc-positive recipients, two auto-HSCT and three allo-HSCT inactive carriers, and 15 allo-HSCT recipients with an anti-HBc-positive donor. Forty-seven (82.4%) patients in this group received LMV prophylaxis (the median (interquartile range, IQR) of LMV treatment was 30 (200-38) months). The second group consisted of 320 anti-HBc-negative auto-HSCT and allo-HSCT recipients with anti-HBc-negative donors. None of these patients received any prophylaxis. Two patients in the first group and two in the second group experienced reactivation of HBV infection, with an incidence of 3.5% (95% CI 0.4-12.1%) and 0.6% (95% CI 0.1-2.2%), respectively. Only one out of four reactivated patients was LMV-treated. The cumulative probability of HBV reactivation at 6 years from HSCT was 15.8% (95% CI 15.2-16.4%). Three of four viral isolates obtained from the HBV-reactivated patients harboured mutations in the immune-active HBsAg-region. In a HSCT population carefully evaluated for HBV prophylaxis, a risk of HBV reactivation persisted in the group of patients who were not LMV-treated. Only one LMV-treated patient experienced reactivation of HBV with a resistant HBV isolate. C. Cerva, CMI 2016;22:946.e1-946.e8 (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.