Management of Hepatitis-B Virus Infection in Immunocompromis
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The aims of the study was to expand the pediatric experience on hepatitis-B virus (HBV) reactivation, a known complication in patients with hematologic malignancies or on immunosuppression. Retrospective appraisal of HBV therapy/prophylaxis was done in immunocompromised children

--18 HBV-positive patients, 5 girls, median age 11.1 years were included. 17 of 18 were immunosuppressed at HBV-infection diagnosis. 17 were at high risk of reactivation, & 1 at moderate risk.

--5 of 18 had acute hepatitis B as first infection or reactivation, 6 had HBeAg-positive infection, 1 an HBeAg-negative infection and 6 HBsAg-negative infection. No HBV-related mortality was observed.

--Prophylaxis had to be repeated in 1. Lamivudine was used in 6/12 viremic patients and HBV-DNA negativization obtained in 2/6. Tenofovir-DF was used in 2/12 and entecavir in 4/12: 100% attained HBV-DNA negativization.

--Therapy had to be switched from tenofovir-DF to entecavir in 1 patient because of renal impairment. Virological breakthroughs were observed in 1 lamivudine-treated patient, leading to a hepatitis flare; 1 patient on entecavir had a hepatitis flare at immunoreconstitution.

--Mortality was 33% in the HBsAg-positive group. 7 prophylactic treatments were administered to 6 patients with HBsAg-negative infection: tenofovir-DF in 2 HBV-DNA-positive, lamivudine in 5 HBV-DNA-negative, without reverse HBsAg seroconversion, morbidity or mortality.

In conclusion, there is a residual risk of acute hepatitis B in immunocompromised children, and the mortality rate was high, possibly due to delays in starting chemotherapy due to liver dysfunction. In immunocompromised infants, tenofovir-DF or entecavir are the drugs of choice for HBV treatment.