Risk of HBV liver disease in isolated antiHbc patients receiving immuno-chemotherapy for non Hodgkin lymphoma

We performed a retrospective study1 in order to clarify the risk of HBV-related liver disease in a large number of isolated anti-HBc positive patients undergoing chemo-immunosuppressive therapy for non-Hodgkin’s lymphoma. So far only limited case reports have been published about this issue and no data on HBV-related risk in this population was available.

While the need of antiviral prophylaxis is well established in HBsAg-positive patients undergoing any sort of chemo-immunosuppressive schedule this is not the case for isolated anti-HBc positive patients. In 2006 the American Society of Hematology suggested either antiviral prophylaxis or close monitoring with targeted therapy.2 Moreover in 2007 the American Society for the Study of Liver Disease stated that there is not enough information to recommend antiviral prophylaxis in isolated anti-HBc positive carriers.3 On the other hand the guidelines of the Italian Association for the study of liver disease4 in 2007 and Barclays et al. in 20085 proposed the administration of universal prophylaxis both to HBsAg positive and HBsAg negative/anti-HBc positive carriers.

Alternatively to the interventional strategy (active drug prophylaxis) monitoring with HBV-DNA has been proposed. However we believe that, for isolated antiHbc carriers, HBV-DNA testing is not a cost/effective strategy neither a rationale approach. Sampling schedule would be arbitrary, thus not assuring timely and clinically efficient detection of a possible reactivation. Moreover HBV-DNA methodology is not well diffused and standardized.

Certainly we want to guarantee the best clinical care to our patients and the prophylaxis strategy in isolated antiHbc patients is a rationale option. Nevertheless at the moment there is not clear evidence based consensus to administrate antiviral prophylaxis to this category of patients undergoing immuno-chemotherapy for non-Hodgkin’s lymphoma.