Prevalence And Clinical Outcome Of Hepatitis B Virus Infection In Patients With Aplastic Anemia

Objective: Although hepatitis B virus(HBV) was supposed to be related with hepatitis associated aplastic anemia(HAAA), the clinical significance of HBV infection without symptomatic hepatitis in patients with aplastic anemia(AA) is uncertain, and its impact on clinical outcome of AA has not been clarified. We aimed to investigate the prevalence of HBV infection and HBV related events in patients with AA who received immunosuppressive therapy.Methods: The medical records of 245 patients with AA from January 2004 to December 2013 were reviewed with respect to HBV infection and HBV related events. The diagnosis of AA was accordance with the criteria of International Agranulocytosis and Aplastic Anemia Study Group. HBV DNA levels were tested by real-time polymerase chain reaction(Light Cycler 480 Roche, Switzerland). Serological HBV markers were detected using chemiluminescent microparticle immunoassay(CMIA) kits(Architech, Abbott Laboratory Diagnostics, USA). Patients who have more than two consecutive data for status of HBV infection with more than 6-month follow up were eligible for HBV reactivation analysis.Results: The presence of HBs Ag was detected in 36(14.69%) of a245 patients with acquired Plasticine anemia. Seven(2.86%) patients were diagnosed HAAA that was defined as patient had experienced hepatitis less than 6 months prior to diagnosis of AA 245 patients with acquired AA were retrospectively investigated. The seven year overall probability of survival was 84.4% for the HBs Ag positive group, 87.5% for HBs Ag negative/ anti-HBc negative group and 81.6% for HBs Ag negative/anti-HBc positive group, which showed no significant difference(p=0.8617). Hepatitis related death was not observed in patients with HBV infection.Among the HBs Ag positive patients, anti-viral prophylaxis was given to three SAA patients before receiving ATG+Cs A. They received lamivudine 8-22 months, and none of them experienced HBV reactivation with the median follow up of 20.3 months(range 8-35 months). 29 HBs Ag positive patients were not given anti-viral agents before IST. Among them, six SAA/VSAA patients received ATG/ALG+Cs A treatment, other 23 patients(SAA/VSAA, n=4; non-SAA, n= 19) received Cs A alone.one(4.76%) HBs Ag positive patients developed HBV reactivation without prophylaxis. One out of 65 HBs Ag-/anti-HBc + patients without prophylaxis experienced HBV reactivation. Of note, no HBV reactivation occurred in patients received Cs A alone.Conclusion: High rate of HBV infection in AA patients calls for further investigations to elucidate the causality of AA and chronic HBV infection without hepatitis. Given the low rate of reactivation and favorable outcome after reactivation in AA patients, close monitoring of HBV DNA, hepatic function and patient immune status could be a feasible approach than routine prophylaxis for AA patients with HBV infection undergoing ATG/ALG+CA treatment. Further studies will help to clarify the optimum time to initiate anti-viral treatment...