https://pubmed.ncbi.nlm.nih.gov/33399328/ hepatitis b

J Pediatr Gastroenterol Nutr. 2020 Dec 30;Publish Ahead of Print. doi: 10.1097/MPG.0000000000003042. Online ahead of print.
Management of Hepatitis-B Virus Infection in Immunocompromised Children. A Single Center Experience

Pier Luigi Calvo 1 , Michele Pinon, Dominic Dell'Olio, Andrea Carpino, Eleonora Biasin, Antonio Pizzol, Silvia Catalano, Licia Peruzzi, Caterina Rigazio, Fabio Cisarò, Anna Opramolla, Sebastian Dorin Asaftei, Paola Quarello, Franca Fagioli

Abstract

Objectives: To expand the pediatric experience on Hepatitis-B Virus (HBV) reactivation, a known complication in patients with hematologic malignancies or on immunosuppression.
Methods: Retrospective appraisal of HBV therapy/prophylaxis in immunocompromised children, studied from April/2006 to March/2020.

Results: 18 HBV-positive patients, 5 girls, median age 11.1 (4.1-17.9) years were included. 17/18 were immunosuppressed at HBV-infection diagnosis. 17 were at high risk of reactivation, one at moderate risk. 5/18 had acute hepatitis B as first infection or reactivation, 6 had HBeAg-positive infection, 1 an HBeAg-negative infection and 6 HBsAg-negative infection. Median follow-up was 2.7 (0.7-12.5) years. No HBV-related mortality was observed. Prophylaxis had to be repeated in one. Lamivudine was used in 6/12 viremic patients and HBV-DNA negativization obtained in 2/6 (33%). 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 one patient, due to renal impairment. Virological breakthroughs were observed in one lamivudine-treated patient, leading to a hepatitis flare; one patient on entecavir had a hepatitis flare at immunoreconstitution. Mortality was 33% in the HBsAg-positive-group.Seven prophylactic treatments were administered to 6 patients with HBsAg-negative infection: tenofovir-DF in two HBV-DNA-positive, lamivudine in 5 HBV-DNA-negative, without reverse HBsAg seroconversion, morbidity or mortality.

Conclusions: There is a residual risk of acute hepatitis B in immunocompromised children, mortality rate was substantial, potentially related to the delays in commencing chemotherapy caused by liver dysfunction. Tenofovir-DF or entecavir are the drugs of choice for HBV treatment in immunocompromised children.