HBcAb-positive Patients Research Articles

HBcAb Positivity as a Risk Factor for Missing HIV RNA Undetectability after the 3TC+DTG Switch.

Hepatitis B Core antibody (HBcAb) positivity is the surrogate marker of hepatitis B occult infection. This condition is not a contraindication for switching to two-drug (2DR) antiretroviral therapy; however, the removal of tenofovir may contribute to poor control of HBV replication. A multicentre retrospective cohort study investigated the impact of HBcAb positivity on HIV control in patients switching to a 2DR with Lamivudine and Dolutegravir (3TC-DTG). In this study, a comparison analysis was conducted between HBcAb-positive and -negative PLWH regarding HIV-RNA suppression, considering: (1): Target Not Detected (TND) < 20 cp/mL; (2) Target Detected (TD) < 20 cp/mL; and (3) Detectable > 20 cp/mL and <50 cp/mL and >50 copies/mL. A total of 267 patients on 2DR with 3TC-DTG were included. In comparison to HBcAb-negative, HBcAb-positive patients were older (45 years [35-54]) and had a lower CD4+ nadir (248 vs. 349 cells/mmc, p = 0.007). No difference in the maintenance of virological suppression was present in the two groups of patients before the switch. Although no patient had an HIV-RNA > 20 cp/mL after the switch, significantly fewer HBcAb-positive compared with -negative subjects resulted in TND at 12, 24, and 36 months after the switch: 52 (69.3%) versus 164 (85.4%), p = 0.004, 50 [72.5%] versus 143 [89.9%], p = 0.001, and 30 [66.7%] versus 90 [92.8%], p = 0.001, respectively. HBcAb positivity is associated with an increased risk of suboptimal HIV suppression during the 36 months after 3TC/DTG simplification. This finding reinforces the relevance of the OBI condition in PLWH and raises the issue of careful virological monitoring of such cases.

#5721 HEPATITIS B VIRUS REACTIVATION IN KIDNEY TRANSPLANT RECIPIENTS TREATED WITH BELATACEPT

Abstract Background and Aims Hepatitis B virus (HBV) reactivation in kidney transplant recipients may be associated with liver failure and graft loss, especially in anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients. Belatacept, a selective costimulation blocker, has been used in kidney transplantation for some time and has been associated with reactivation of other viruses as BK or CMV. However, there are few data on HBV reactivation among kidney recipients treated with belatacept. Method We performed a retrospective study in two French kidney transplantation centres including all transplant recipients receiving belatacept. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes and risks factors. Results 135 patients treated with belatacept were included, and 32 were HBcAb-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7%); reactivation occurred 54.8 (± 70.9) months after transplantation. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (p = 0.363) and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (p = 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation. Conclusion Compared to the few studies that exist in this area, the HBV reactivation rate was high in patients treated with belatacept in our study. Our findings suggest that systematic antiviral prophylaxis for anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients should be considered and that there should be close monitoring of HBV serology and viral load in these patients to detect early HBV reactivation.

Safety of secukinumab in the treatment of patients with axial spondyloarthritis and concurrent hepatitis B virus infection or latent tuberculosis infection.

To evaluate the safety of secukinumab (SEC) in the treatment of patients with axial spondyloarthritis (axSpA) and concurrent hepatitis B virus (HBV) infection or latent tuberculosis infection (LTBI). This is a retrospective cohort study. Adult axSpA patients with HBV infection or LTBI receiving SEC treatment for at least 3months from March 2020 to July 2022 in Guangdong Provincial People's Hospital were included. Patients were screened for HBV infection and LTBI before SEC treatment. During follow-up, reactivation of HBV infection and LTBI was monitored. Relevant data were collected and analyzed. A total of 43 axSpA patients with HBV infection or LTBI were included, of whom 37 were with HBV infection, 6 were with LTBI. Six out of thirty-seven (16.2%) patients with axSpA and concurrent HBV infection exhibited HBV reactivation after 9.0 ± 5.7months of SEC treatment. Among them, 3 patients had chronic HBV infection and received anti-HBV prophylaxis, 2 patients had chronic HBV infection but did not receive anti-HBV prophylaxis, and 1 patient had occult HBV infection and did not receive antiviral prophylaxis. None of the 6 axSpA patients with LTBI developed reactivation of LTBI, whether received anti-TB prophylaxis or not. HBV reactivation can occur in axSpA patients with different types of HBV infection undergoing SEC treatment, whether receive antiviral prophylaxis or not. Close monitoring of HBV reactivation in axSpA patients with HBV infection undergoing SEC treatment is mandatory. Anti-HBV prophylaxis may be beneficial. In contrast, SEC may be safe in axSpA patients with LTBI, even in patients not receiving anti-TB prophylaxis. Key Points •Currently, most evidence about the safety of SEC in patients with HBV infection and LTBI were from patients with psoriasis. Our study adds data about the safety of SEC in Chinese axSpA patients with concurrent HBV infection or LTBI in real-world clinical setting. •Our study showed that HBV reactivation can occur in axSpA patients with different types of HBV infection undergoing SEC treatment, whether receive antiviral prophylaxis or not. •Close monitoring of serum HBV markers, HBV DNA load, and liver function is mandatory in axSpA patients with chronic, occult, and resolved HBV infection undergoing SEC treatment. Anti-HBV prophylaxis may be beneficial in all HBsAg-positive patients and HBsAg-negative, HBcAb-positive patients at high risk of HBV reactivation who are receiving SEC therapy. •None of the axSpA patients with LTBI, whether received anti-TB prophylaxis or not, developed reactivation of LTBI in our study. SEC may be safe in axSpA patients with LTBI, even in patients not receiving anti-TB prophylaxis.

Hepatitis B Virus Reactivation in Kidney Transplant Recipients Treated With Belatacept

Hepatitis B virus (HBV) reactivation in kidney transplant recipients has been reported in 3% to 9% of anti-HBc antibody (HBcAb)-positive HBs antigen (HBsAg)-negative patients. It has not been studied in patients receiving belatacept, a selective costimulation blocker. We performed a retrospective study of all transplant recipients receiving belatacept in 2 kidney transplantation centers in France. Among HBcAb-positive patients, we analyzed HBV reactivation rate, outcomes, and risk factors. A total of 135 patients treated with belatacept were included: 32 were HBcAb-positive and 2 were HBsAg-positive. Seven patients reactivated HBV (21.9% of HBcAb-positive patients), including 5 HBsAg-negative patients (16.7% of HBcAb-positive HBsAg-negative patients). Reactivation occurred 54.8 (± 70.9) months after transplantation. One patient presented with severe hepatitis and 1 patient developed cirrhosis. There was no significant difference in survival between patients that reactivated HBV and patients that did not: 5-year patient survival of 100% (28.6; 100) and 83.4% (67.6; 100), respectively (P= 0.363); and 5-year graft survival of 100% (28.6; 100) and 79.8% (61.7; 100), respectively (P= 0.335). No factor, including HBsAb positivity and antiviral prophylaxis, was statistically associated with the risk of HBV reactivation. HBV reactivation rate was high in patients treated with belatacept when compared with previous transplantation studies. HBV reactivation did not impact survival. Further studies are needed to confirm these results. A systematic antiviral prophylaxis for these patients should be considered and evaluated.

HBcAb positivity increases the risk of postoperative complications after extended hemihepatectomy for hilar cholangiocarcinoma.

Hepatitis B core antibody (HBcAb) positivity is considered a prior hepatitis B virus (HBV) infection. However, little is known about the effect of HBcAb positivity on surgical safety for hilar cholangiocarcinoma (hCCA). The present study aims to investigate the role of HBcAb positivity on postoperative complications of hCCA. A retrospective analysis was performed on the status of HBcAb positivity, liver fibrosis, perioperative surgical complications, and long-term outcomes of hCCA patients with Hepatitis B surface antigen (HBsAg) negativity who underwent surgical treatment in Tongji Hospital from April 2012 to September 2019. HBcAb positivity with negative HBsAg occurs in 137 hCCA patients (63.1%). A total of 99 hCCA patients with negative HBsAg underwent extended hemihepatectomy, of whom 69 (69.7%) and 30 (30.3%) were HBcAb-positive and HBcAb-negative, respectively. Significant fibrosis was detected in 63.8% of the patients with HBcAb-positive, which was markedly higher than those with HBcAb-negative (36.7%) (p=0.016). The postoperative complications and 90-day mortality rates were 37.4% (37/99) and 8.1% (8/99), respectively. The incidence of postoperative complications in HBcAb-positive patients (44.9%) was significantly higher than that in HBcAb-negative patients (20.0%) (p=0.018). All the patients who died within 30-day after surgery were HBcAb-positive. Multivariate analysis showed that the independent risk factors for complications were HBcAb positivity, preoperative cholangitis, portal occlusion >15 min, and significant fibrosis. There were no significant differences in recurrence-free survival (RFS) and overall survival (OS) between HBcAb-positive and HBcAb-negative patients (p=0.642 and p=0.400, respectively). HBcAb positivity is a common phenomenon in hCCA patients from China, a country with highly prevalent HBcAb positivity. The status of HBcAb-positive markedly increases the incidence of postoperative complications after extended hemihepatectomy for hCCA patients.

Role of lower dose hepatitis B immune globulin prophylaxis in liver transplantation: A single center perspective.

Prevention of hepatitis B virus (HBV) reinfection is important for long-term outcomes following liver transplantation (LT). Hepatitis B immunoglobulin (HBIG) is used among recipients who have (i) native HBV disease, (ii) hepatitis B core antibody positivity (HBcAb positivity), or (iii) received HBcAb positive organs. Nucleos(t)ide analogue (NA) monotherapy is emerging for treating patients in this setting. There is no generalized consensus on the ideal dosage of HBIG. The aim of this study was to evaluate the efficacy of low-dose HBIG (1560 international unit [IU]) for post-LT HBV prevention. HBcAb positive patients who received either HBcAb positive or hepatitis B core antibody negative (HBcAb negative) organs and HBcAb negative patients who received HBcAb positive organs between January 2016 and December 2020 were reviewed. Pre-LT HBV serologies were collected. HBV-prophylaxis strategy included NA with/without HBIG. HBV recurrence was defined as HBV deoxyribonucleic acid (DNA) positivity during the 1-year, post-LT follow-up. No HBV surface antibody titers were followed. A total of 103 patients with a median age of 60 years participated in the study. Hepatitis C virus was the most common etiology. Thirty-seven HBcAb negative recipients and 11 HBcAb positive recipients with undetectable HBV DNA received HBcAb positive organs and underwent prophylaxis with 4 doses of low-dose HBIG and NA. None of the recipients in our cohort had a recurrence of HBV at 1 year. Low-dose HBIG (1560 IU) × 4 days and NA, for HBcAb positive recipients and HBcAb positive donors, appear to be effective in preventing HBV reinfection during the post-LT period. Further trials are needed to confirm this observation.

Hepatitis B sero-prevalence among hematology patients: importance of Anti-HbcAb and efficiency of antiviral prophylaxis.

Hepatitis B infection is an important problem in immune suppressed patients. Anti HbcAb is an important marker that shows past exposure to virus. In this study, we retrospectively searched HBV serology among the patients who had Bone Marrow Transplantation (BMT) or chemotherapies (CT) at Medicalpark Izmir Hospital Bone Marrow Transplantation Unit; changes in viral parameters throughout therapy; and tried to find the efficiency of antiviral prophylaxis. We retrospectively evaluated the viral parameters; HbsAg, Anti HbsAb, Anti Hbc IgG, HbeAg, Anti Hbe Ab, HBV DNA, HCV RNA which were carried out before BMT and CT. We grouped the patients as latent HBV infection and inactive carriers. Started antiviral treatment as prophylaxis, monitored the changes in serological parameters and defined HBV related situations. A total of 584 patients were evaluated retrospectively. Twenty patients were having latent HBV infection. Ten patients were inactive carriers of HBV. In post-transplant period, the patients were screened for 11 months (1-38 months). None of the patients experienced HBV activation during follow period. The best approach in HbcAb positive patients with planned immunosuppressive treatment is the use of anti-viral agents before immune suppression and close monitoring of the patients HBV-related markers.

Surveillance of Liver Function in Uveitis with or without Chronic HBV Infection

Introduction: Immunosuppressive therapy for uveitis may cause liver damage. Methods: To investigate incidence of liver damage during uveitis treatment, we compared serological Hepatitis B core antibody (HBcAb) status with risk of liver dysfunction in all participants (n = 992), in anterior uveitis (AU) (n = 489), and combined of intermediate, posterior, or panuveitis (IPPU) patients (n = 503). The primary endpoint was incidence of elevated serum alanine aminotransferase level above 2-fold upper limits of normal within 6 months. Results: The incidence rate of primary endpoint for HBcAb-negative and HBcAb-positive patients was 65 and 212 per 1,000 person years, respectively. The absolute rate difference was 147 (95% confidence interval [CI], 80–213) per 1,000 person years. HBcAb positivity was associated with a higher risk for primary endpoint in all participants (adjusted hazard ratio [aHR], 3.53; 95% CI, 1.79–6.99; p value = 2.8 × 10⁻⁴) and in IPPU (aHR, 3.80; 95% CI, 1.61–9.01; p value = 0.002). No significant association with primary endpoint was observed for HBcAb positivity in AU (aHR, 3.21; 95% CI, 0.94–10.95; p value = 0.063). AU was mainly treated with topical eye drops (74.0%), whereas IPPU cases received systemic therapy including prednisone (94.0%), cyclosporine (80.9%), or other additionally combined immunomodulatory agents (14.9%). Conclusion: Noninfectious uveitis cases with HBcAb positivity have an increased risk of liver damage. This association was predominantly driven by IPPU but was not significant in AU, suggesting that the association is mediated by systemic therapy.

Long-Term Safety in HBsAg-Negative, HBcAb-Positive Patients with Rheumatic Diseases Receiving Maintained Steroid Therapy after Pulse Therapy.

The risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-negative, antibody to hepatitis B core antigen (anti-HBc)-positive patients after glucocorticoid (GC) pulse therapy remains unclear. Aims: Our study aimed to examine the safety of GC pulse therapy in HBsAg-negative, anti-HBc-positive rheumatic patients. Methods: Medical records of HBsAg-negative, anti-HBc-positive patients receiving GC pulse therapy to treat rheumatic diseases were reviewed. The primary outcome was HBV-associated hepatitis occurring within the first year after GC pulse therapy; the secondary outcome was HBsAg seroreversion occurring during the follow-up period. Results: We identified 5222 HBsAg-negative, anti-HBc-positive patients with rheumatic diseases who had attended Taichung Veterans General Hospital from October 2006 to December 2018. A total of 689 patients had received GC pulse therapy, with 424 patients being analyzed. Hepatitis was noted in 28 patients (6.6%) within the first year after GC pulse therapy, but none had been diagnosed as HBV-associated hepatitis. Three patients (0.7%) later developed HBsAg seroreversion, with a median interval of 97 months from the first episode of GC pulse therapy. These cases concurrently had maintained high dose oral prednisolone (≥20 mg prednisolone daily for over 4 weeks). Conclusions: Amongst the HBsAg-negative, anti-HBc-positive rheumatic patients treated with GC pulse therapy, the risk of HBV-associated hepatitis within the first year was low. HBsAg seroreversion may have developed in the later stage, but only in those patients who had maintained high-dose oral steroid.

Hepatitis B virus infection among patients with Rheumatoid Arthritis in Suez Canal University Hospital

Background: About 350 million individuals are considered having hepatitis B virus (HBV) infections worldwide, and 6.8% of cases have been observed of a reactivation of HBV triggered by immunosuppressive medications. Due to HBV reactivation, biologic or non-biological Synthetic antirheumatic disease-modifying drugs may be involved. For rheumatologists, HBV infection is a big concern. Patients and Methods: A descriptive cross-sectional study was carried out at Rheumatology outpatient clinic at Suez Canal University Hospital, Ismailia, during the period from 22 of January to 30 of July 2020 and included 200 patients with a history of Rheumatoid Arthritis. Patients were asked about their demographics and possible risk factors, and blood samples were collected for detection of HBV markers. Results: Evidence of present or past HBV infection with positive anti-HBc was found in 12% of patients (n=24). Among them, 4 patients had Overt HBV infection with positive HBsAg (2%) and another 4 patients had Occult hepatitis B, with negative HBsAg and positive HBV DNA (2%). Regarding HBV vaccination status, we found that 4 patients (16.7%) of HBc Ab positive patients were vaccinated and 69 patients (39.2%) of HBc Ab negative patients were vaccinated. Conclusion: This research indicates that HBV among rheumatoid arthritis patients is comparatively prevalent. Moreover, HBV carriers experience rheumatological symptoms. Risk factors for HBV infection in patients with Rheumatoid Arthritis included history of needle stick injury, dental visits, and prior surgical procedures.

Characteristics of Patients with Cryptogenic Cirrhosis: A Retrospective Study

Backgrounds: This study aimed to achieve a better understanding of the characteristics of patients with cryptogenic cirrhosis (CC). Methods: We retrospectively enrolled 50 patients with CC between January 2018 and December 2020 who were admitted to our hospital. Clinical data, biochemical and immunological parameters, viral markers, imaging findings and liver histopathological features of the patients were analyzed. Results: The percentage of male patients with CC was 58% (29/50). The average age was 54 ± 17 years. Hepatitis C virus (HCV) IgG and hepatitis B surface antigen (HBsAg) were negative for all patients. Hepatitis B virus (HBV) DNA was tested in 68% (34/50) of the patients and the results were undetectable. Ceruloplasmin was detected in 96% (48/50) cases, while 10 cases were Kayser-fleischer ring negative. Immunological tests were conducted in 94% (47/50) of cases, antinuclear antibody (ANA) was elevated in eight cases, whereas anti-mitochondrial antibody (AMA) was elevated in three cases. Liver biopsy was conducted on 11 patients, of which seven were percutaneous and four were transjugular. Immunohistochemistry for HBsAg and HBcAg were all negative. Metavir scoring result showed that six of 11 patients had scores below G2S2. Conclusions: The common laboratory tests especially noninvasive ones were conducted for most of the patients. Diagnosis of CC requires further detection to exclude specific diagnosis such as HBV DNA or intrahepatic covalently closed circular DNA (cccDNA) in HBcAb positive patients, genetic screening of Wilson’s Disease in patients with low ceruloplasmin, etc.

High Prevalence of Occult Hepatitis B Virus Infection among Frequently Blood Transfused Children: A Single Egyptian Center Experience

Background Occult hepatitis B virus (HBV) infection (OBI) is a form of the disease which does not present with Hepatitis B surface antigens (HBsAg) in the serum of patients with HBV DNA being detectable in the serum and hepatocytes. OBI is an important risk factor for acquiring post transfusion hepatitis. This could lead to reactivation of the HBV, liver cirrhosis, and hepatocellular carcinoma. We aimed to examine the prevalence of OBI in frequent blood and blood product transfused Egyptian pediatric patients. Materials and Methods: This case-control study was done in pediatric department, Minia University. Forty-five patients randomly selected from the blood transfusion unit in the central Minia blood bank were enrolled. Their age ranged from 3-18 years. Another 12 known hepatitis B positive age- and sex-matched patients were enrolled as controls. Routine AST, ALT, blood urea, serum creatinine, and hemoglobin levels were done, HBsAg, anti-hepatitis B surface antibodies (anti-HBsAb), anti-hepatitis B core antibodies (anti-HBcAb), and HBV DNA (by nested PCR) were examined for both patients and controls. Results: Although anti-HBs serum levels were ≥10IU/L, HBV DNA was present in 27 (60%) of the 45 HBsAg negative patients. Thirteen (48%) of the OBI patients were anti-HBcAb positive. No significant differences were found between HbcAb positive and negative OBI groups regarding age, gender, frequency of blood transfusion, presence of hepatomegaly, presence of splenomegaly, serum ferritin, AST, ALT, blood urea, serum creatinine, and hemoglobin levels. On the other hand, Hepatitis C Virus Ab positivity was significantly higher among HbcAb positive patients (p=0.02). Conclusion Based on the results, the risk of acquiring OBI is high in patients receiving frequent blood transfusions despite obligatory HBV vaccination.

Reactivation of Hepatitis B Virus Infection in Aplastic Anemia Patients Receiving Immunosuppressive Therapy

▪Objective: The aim of this study was to assess the risk of HBV reactivation in HBsAg-positive or negative, HBcAb-positive patients with aplastic anemia (AA) receiving immunosuppressive therapy.Methods: We analyzed clinical data of 60 AA patients with HBV infection out of 201 cases. Entecavir or lamivudine therapy was initiated if HBV reactivation was encountered, or used as antiviral prophylaxis regimen for HBsAg-positive patients.Result: Among 60 AA patients, 12 were chronically infected and 48 were previously exposed. There was no difference in clinical features in AA patients with or without HBV infection. The prevalence of non-severe AA (NSAA) progressed to severe AA (SAA) was similar in two groups (35.6% vs 42.7%, p=1.0). In NSAA group, the response rate to CsA, to ATG and CsA, and progression to SAA were similar in patients with or without HBV infection (35.7% vs 35.3%, p>0.05; 42.8% vs 58.8%, p= 1.0; 35.5% vs 42.7%, p= 0.414). In SAA group, patients with or without HBV infection responded to ATG and CsA therapy similarly (83.33% vs 59.0%, p = 0.252). HBV reactivation was occurred in all 5 HBsAg positive patients without any antiviral therapy, while no HBV reactivation happened in other 7 patients received antiviral therapy. Disease course (RR=1.012, p=0.036) and absolute reticulocyte count (RR=11.556, P=0.025) were the risk factors for HBV reactivation by univariate analysis. Logistic regression indicated that HBsAg positivity without preventive therapy was the only strong factor for HBV reactivation.Conclusion: Antiviral prophylaxis is recommended for HBsAg-positive patients with AA who will receive IST because of high rate of HBV reactivation. HBV infection has no influence on the clinic course of AA, and antiviral therapy does not affect the efficacy of IST. DisclosuresNo relevant conflicts of interest to declare.

Hepatitis B Reactivation in the DAA Era: Minding the Gap Between the Black Box and Clinical Practice

The US Food and Drug Administration recently issued a black box warning regarding the risk of hepatitis B virus (HBV) reactivation with direct-acting antiviral (DAA) treatment in hepatitis C virus (HCV)-coinfected individuals. The warning included all HBV infection, active and resolved, which, along with the lack of consensus among the gastroenterology and hepatology guidelines, have left clinicians unsure on how to proceed. Recent data have filled some knowledge gaps regarding the true risk of HBV reactivation in HCV treatment. The clinical data pertaining to the risk of reactivation in active and resolved HBV infection are reviewed, and potential prevention and management strategies are proposed, noting there are still some knowledge gaps remaining. Recent large prospective studies of HBV/HCV-coinfected patients, along with the largest meta-analysis of such patients to date, provide additional insight into the risk of HBV reactivation with HCV antiviral treatment. Subclinical HBV reactivation is not uncommon, occurring in about 25% of patients, but the risk of clinically significant events such as hepatitis remains low in HBsAg-positive individuals, and even lower in isolated HBcAb-positive patients. However, recent case reports have brought to light particular situations, such as concomitant immunosuppression, as potential pitfalls to the previous low risk of reactivation attributed to resolved infection. Recent prospective data and a large meta-analysis confirm that clinically significant HBV reactivation remains an uncommon event with the use of DAAs in HBsAg-positive patients, and even rarer in isolated HBcAb-positive cases.

No evidence of hepatitis B virus reactivation in patients with resolved infection treated with direct-acting antivirals for hepatitis C in a large real-world cohort.

Hepatitis B virus (HBV) reactivation has been observed following interferon (IFN)-based treatment in HBV/hepatitis C virus (HCV) co-infected patients. Recent reports suggest that reactivation may also occur in both hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative patients during HCV treatment with direct-acting antivirals (DAAs). To investigate the rate of patients with HBV reactivation during IFN-based and IFN-free HCV treatment in a large real-world cohort. A total of 848 patients with chronic hepatitis C were treated with different combinations of DAAs. Among patients with available outcome and HBV data, there were 272 patients hepatitis B core antibody (HBcAb)-positive (HBsAg-positive, n=9; HBsAg-negative, n=263), and 536 were HBcAb-negative. All HBcAb-positive patients were tested for HBV DNA at the end of DAA therapy and alanine transaminase (ALT) levels were frequently measured during therapy and follow-up. Seventy-three percent (n=192/263) of HBsAg-negative/HBcAb-positive patients had elevated ALT levels at baseline, which declined to normal values in all but 18 patients, and no HBV reactivation was observed. Eight patients had detectable but not quantifiable HBV DNA (<20 IU/mL) at end of treatment, but none were associated with elevated ALT. Five of nine HBsAg-positive/HBcAb-positive patients experienced transient or permanent HBV reactivation, three of whom required nucleos(t)ide treatment during (n=1) or after (n=2) DAA therapy. HBV reactivation was not observed in HBsAg-negative/HBcAb-positive patients but common in HBsAg-positive/HBcAb-positive patients treated with different combinations of DAAs for HCV.

P187 Estimating cost savings by introducing a reflex Hepatitis B virus screening algorithm in a sexual health service

Background/introduction BASHH recommends that screening for HBV infection may be with HBcAb, with reflex HBsAg testing in HBcAb-positive patients. False negative HBcAb (eg in acute HBV infection or with low assay sensitivity) is rare. At the time our laboratory did not routinely perform reflex HBsAg testing, placing the onus on clinicians, many of whom therefore requested both tests simultaneously (with redundant sAg tests being performed in the presence of a negative cAb). We wished to audit the extent of this practice and estimate cost savings by introducing reflex testing. Aim(s)/objectives This was a retrospective case notes review of patients for whom HBcAb had been requested between 01/01/15 and 01/05/15. The cost of performing HBsAg testing was estimated at £3.60 per test. Methods There were two hundred patients with HBcAb results: 110 (55%) male; median age 32 (IQR 26–39) years; 9 (4.5%) HIV-infected. Twenty-two (11%) tested HBcAb-positive of whom 5 (2.5%) were HBsAg-positive, 16 (8.0%) HBsAg-negative and 1 (0.5%) not tested for HBsAg. Of the HBcAb-positive individuals, requesting details were available for 10 cases: for 8/10 both HBsAg and HBcAb were requested initially. Of 178 (89.0%) HBcAb-negative individuals, HBsAg was performed for 49 (24.5%); all were HBsAg-negative. Across the Trust, 11,500 HBcAb tests were requested in 12 months. Assuming 89.0% HBcAb-negativity, the cost of testing 24.5% of these patients for HBsAg would almost reach £10,000. Results Reducing HBsAg testing in HBcAb-negative individuals would provide savings. Reflex laboratory HBsAg should be implemented for HBcAb-positive patients.

Positive HBcAb is associated with higher risk of early recurrence and poorer survival after curative resection of HBV-related HCC.

Previous studies predicted the prognosis of hepatocellular carcinoma (HCC) mainly based on tumour-related factors, whereas the impacts of hepatitis B virus (HBV)-related factors are usually ignored. The objective of this exploratory study was to investigate the prognostic role of hepatitis B core antibody (HBcAb) on post-operative survival and recurrence of HCC. A retrospective analysis of 3388 HBsAg positive (HBV-related) HCC patients treated by curative resection was performed. Multivariate analysis of independent prognostic factors was performed by Cox proportional hazards regression model. HBcAb positivity was an independent prognostic factor for recurrence-free survival (RFS) of HBV-related patients (P < 0.001, HR: 1.723, 95% CI: 1.278-2.324), and the 1-, 3-, 5-year RFS rates for HBcAb-negative patients were significantly better than those of HBcAb-positive patients (92.5%, 72.1% and 65.9% vs 77.9%, 58.6% and 46.9%, P < 0.001). HBcAb-positive HCC was much bigger (P = 0.006), more often involved with vascular invasion (P = 0.001), elevated AFP (P = 0.001) and ALT (P = 0.046) levels, but less often involved with capsule formation (P = 0.034). Besides vascular invasion, tumour size, interferon-α treatment, AFP and GGT level, HBcAb positivity was an independent prognostic factor for early intrahepatic recurrence of HBV-related patients (P = 0.025, HR: 1.766, 95% CI: 1.073-2.907) and the majority of HBcAb-positive recurrence were early recurrence while most of HBcAb-negative recurrence were late recurrence (P = 0.004). Positive HBcAb may represent a more invasive phenotype of HBV-related HCC, and is associated with a higher risk of early intrahepatic recurrence and poorer RFS of HBV-related patients after curative resection.

The prevalence of isolated hepatitis B core antibody and its related risk factors among male injected drug users in Isfahan prisons.

Background:The prevalence of isolated hepatitis B core antibody (anti-HBc) varies between 1% and 30% in different populations. Isolated anti-HBc-positive patients who suffer from occult hepatitis B virus (HBV) infection have the potential to transmit HBV infection. So isolated anti-HBc screening is a valuable tool to prevent HBV transmission. Considering the importance of isolated anti-HBc screening and high prevalence of HBV among injected drug users (IDU) prisoners, we designed this study to evaluate the isolated anti-HBc positivity among inmates with the history of IDU in our area.Materials and Methods:We did this cross-sectional study from September 2009 to March 2010 among volunteer male IDU prisoners in Isfahan. Blood samples were taken from all of subjects and tested for HBV markers. Then a questionnaire containing socio-demographic, drug histories and high risk behaviors information was completed for all participants. Data analysis was done utilizing univariate analysis and multiple logistic regressions. A P < 0.05 was considered significant.Results:Totally 970 male IDU prisoners (mean age 32.6 ± 8.1) were included in our study. The prevalence of isolated HBc Ab was 4.5%. Isolated anti-HBc significantly was related to tooth filling (OR: 2.62, CI: 1.20-7.14) and imprisonment (OR: 3.95, CI: 1.39-11.18). We couldn’t find any relationship between isolated anti-HBc positivity and addiction duration, incarceration frequency, recent incarceration duration or number of injection per month.Conclusion:For screening high risk groups in parallel with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and other viral markers, maybe it is better to check HBcAb too, because isolated HBcAb-positive patients may have occult hepatitis B infection which could transfer the infection to others.

O3-5-1 - Safe Administration of Ambulatory Chemotherapy Center

Background: Previous studies of the safety of outpatient chemotherapy of severe adverse events (SAEs) and chemotherapy errors do not clearly consider the prevention. Objective: We treat approximately 2,500 outpatient-years with chemotherapy without explicit criteria in our ambulatory chemotherapy center (ACC). Our purpose is to develop safety, efficiency and risk management in our ACC by clarifying safety standards. Method, We investigated 3,067 case-years that reserved chemotherapy at ACC between Jun, 2012 and May, 2013. We have studied the effectiveness using criteria received chemotherapy in our ACC. In addition, to prevent HBV reactivation, we have tested newly-outpatients (n = 332) for serologic markers of HBV infection before chemotherapy.Results: The median age was 65 years. Treatment-related grade 3 or 4 adverse events were discontinued or deferred. HBsAg-positive, HBsAb-positive and HBcAb-positive patients were 0.9%(3 of 332), 13.8% (46 of 332) and 15% (3 of 332). Nobody developed HBV reactivation in our ACC.Conclusion: In this study, the chemotherapy received rate is relatively high, SAEs are low. The results suggest strategies for prevention in the outpatient chemotherapy.

Management of the HBV reactivation in isolated HBcAb positive patients affected with Non Hodgkin Lymphoma

BackgroundOccult HBV infection (OBI) is defined by the persistence of HBV in the liver without serum HBsAg and HBVDNA. It represents a life-threatening event during immunosuppressive chemotherapies. An OBI occurs in approximately 18% of HBcAb + patients. International guidelines suggest surveillance for HBV markers in immunosuppressed patients. In Non-Hodgkin Lymphoma (NHL), the prevalence of OBI reactivation remains to be established.MethodsIn order to determine the prevalence of occult HBV reactivation in a large cohort of patients during chemotherapy for NHL, we analysed 498 NHL patients in a centre of Southern Italy. We evaluated HBV markers, NHL type, treatment type and occurrence of HBV reactivation.ResultsForty % of patients were treated with monoclonal antibodies and 60.3% without. Ninety-six patients were HBcAb+, HBsAg-. HBV reactivation occurred in ten subjects of this subgroup. All of them were successfully treated with Lamivudine. None of the patients experienced liver-related death. The prevalence of OBI reactivation was of 10.42% in HBcAb + HBsAb- patients. This event occurred in 50% of patients treated with mild immunosuppressive therapies. Each reactivation was treated with Lamivudine.DiscussionThis report suggests that a strict surveillance is important and cost-effective in HBcAb + HBsAg- NHL patients treated with mild immunosuppressive therapies, in order to detect an occult HBV reactivation.