Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/35846
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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBUZO, Bruno Fernando
dc.contributor.authorRAMOS, Jessica Fernandes
dc.contributor.authorROSSETTI, Renata Ariza Marques
dc.contributor.authorSALLES, Nanci
dc.contributor.authorMEDRONE-JUNIOR, Alfredo
dc.contributor.authorROCHA, Vanderson
dc.contributor.authorNASTRI, Ana Catharina de Seixas Santos
dc.date.accessioned2020-06-01T14:46:41Z
dc.date.available2020-06-01T14:46:41Z
dc.date.issued2020
dc.identifier.citationTRANSPLANT INFECTIOUS DISEASE, v.22, n.2, article ID e13243, 9p, 2020
dc.identifier.issn1398-2273
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/35846
dc.description.abstractBackground Hepatitis B virus (HBV) infection is a worldwide concern with a broad distribution. In immunosuppressed populations, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients, it can reactivate leading to acute hepatic failure. Different risk factors are known for higher rates of reactivation, and entecavir, tenofovir, and lamivudine are often used for prophylaxis and treatment. However, data regarding the impact of antiviral drugs in neutrophil and platelet engraftment are still unknown and concern the management of viral hepatitis post-HSCT. Methods We performed a single-center, retrospective, observational study reviewing medical records of patients referred for hematopoietic stem cell transplant from 2010 to 2017, which were also HBV infected, aiming to describe outcomes related to antiviral treatment and also the impact on platelet and neutrophil recovery after transplant. A secondary goal consisted of analyzing the impact of HBV infection in early and late mortality post-HSCT. The study included patients with positive blood bank screening for hepatitis B infection (HBsAg, Anti-HBc or HBV-NAT), confirmed later on by a laboratory routine serology. Results A total of 1132 hematopoietic stem cell recipients were assessed between 2010 and 2017. Eighty-six patients were confirmed to have HBV infection, of which six were HBsAg-positive, 20 were isolated anti-HBc-positive, and 60 had resolved infection (anti-HBc-positive and anti-HBs-positive). With regard to prophylaxis, 19 patients underwent HSCT on HBV antiviral therapy or prophylaxis: two were HBeAg-positive, three were HBeAg-negative and HBV-DNA was only detectable in three of them. Moreover, one patient had an occult HBV infection. Regarding therapy, 9 patients were on entecavir, 6 patients on lamivudine, two on tenofovir, and two of them on a combination of tenofovir + lamivudine due to HIV co-infection. Reverse seroconversion was not identified in any patients receiving antiviral therapy or prophylaxis, but it was detected in one patient with occult hepatitis B and another with resolved infection. No severe side effects led to therapy discontinuation in the treated group, which also did not have any significant delay in neutrophil or platelet engraftment when compared to patients without antiviral therapy. In addition, the only factors associated with increased mortality were transplant onset after 50 years, allogeneic transplant and myeloablative conditioning regimens. Interestingly, the presence of HBsAg or detectable HBV-DNA was not related to worse outcomes, neither the use of rituximab. In multivariate analysis, the use of antiviral therapy, the occurrence of graft-versus-host disease or CMV reactivation also was not linked to increased mortality. Conclusions To sum up, HBV serology, ALT, and HBV-DNA monitoring are essential to detect hepatic flares earlier, even in populations with chronic inactive hepatitis, due to the possibility of later seroconversion. HBV infection was not related to increased 2-year mortality post-transplant. Antiviral prophylaxis did not cause any important clinical or laboratory side effects that could demand discontinuation, and its use was not associated with later neutrophil and platelet engraftments.eng
dc.language.isoeng
dc.publisherWILEYeng
dc.relation.ispartofTransplant Infectious Disease
dc.rightsrestrictedAccesseng
dc.subjectantiviral therapyeng
dc.subjectbone marrow transplanteng
dc.subjecthematopoietic stem cell transplanteng
dc.subjecthepatitis Beng
dc.subjectneutrophil engraftmenteng
dc.subjectplatelet engraftmenteng
dc.subjectreactivationeng
dc.subject.othercore-positive donorseng
dc.subject.otherliver-transplantationeng
dc.subject.otherhbv reactivationeng
dc.subject.otherpreventioneng
dc.subject.otherlamivudineeng
dc.subject.otherinfectioneng
dc.subject.othertherapyeng
dc.subject.otherriskeng
dc.subject.otherprophylaxiseng
dc.subject.otherguidelineseng
dc.titleHepatitis B virus among hematopoietic stem cell transplant recipients: Antiviral impact in seroconversion, engraftment, and mortality in a Latin American centereng
dc.typearticleeng
dc.rights.holderCopyright WILEYeng
dc.identifier.doi10.1111/tid.13243
dc.identifier.pmid31901206
dc.subject.wosImmunologyeng
dc.subject.wosInfectious Diseaseseng
dc.subject.wosTransplantationeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
hcfmusp.author.externalSALLES, Nanci:Hosp Clin HCFMUSP, Fundacao Prosangue, Sao Paulo, Brazil
hcfmusp.description.articlenumbere13243
hcfmusp.description.issue2
hcfmusp.description.volume22
hcfmusp.origemWOS
hcfmusp.origem.idWOS:000506876200001
hcfmusp.origem.id2-s2.0-85077862612
hcfmusp.publisher.cityHOBOKENeng
hcfmusp.publisher.countryUSAeng
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dc.description.indexMEDLINEeng
dc.identifier.eissn1399-3062
hcfmusp.citation.scopus1-
hcfmusp.scopus.lastupdate2022-04-29-
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Artigos e Materiais de Revistas Científicas - FM/MCM
Departamento de Clínica Médica - FM/MCM

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - IMT
Instituto de Medicina Tropical - IMT

Artigos e Materiais de Revistas Científicas - LIM/31
LIM/31 - Laboratório de Genética e Hematologia Molecular

Artigos e Materiais de Revistas Científicas - ODS/03
ODS/03 - Saúde e bem-estar


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