ABSTRACT
Natural history of hepatitis B virus in patients with cancer (Table 17.1) When chemotherapy is given for the treatment of cancer in patients who are infected with hepatitis B virus (HBV), there is a high frequency of liver-related morbidity and mortality.1-5 This is a particularly troublesome problem in countries where HBV is endemic. In Hong Kong, for example, 10% of the population is serologically positive for hepatitis B surface antigen (HBsAg) and another 40% is positive for the corresponding antibody (anti-HBs).6,7 The risk of severe hepatitis B after chemotherapy is probably higher when the underlying malignancy is hematological, when the chemotherapy is more immunosuppressive, and when the viral load in the liver is high,2,4,5 but prediction of outcome in individual patients is difficult.7-9 In the setting of autologous hematopoietic stem cell (HSC) transplantation (HSCT), a high pre-
transplant HBV DNA level in serum is associated with a higher incidence of post-transplant hepatitis due to HBV reactivation.9
