Patients receiving lamivudine prophylaxis should be monitored with serial HBV DNA assays, and formal testing for lamivudine resistance should be performed if there is a 1 log increase in HBV DNA.86 Once resistance is confirmed, patients should be given adefovir in addition to lamivudine
or changed to tenofovir if this is available. Patients receiving intensive chemotherapy who are positive for HBcAb but HBsAg negative should have a sensitive HBV DNA assay performed to determine whether they have occult HBV infection. If HBV DNA is detected, these patients should be treated as for positive-HBsAg patients. Patients with undetectable KU-60019 HBV DNA should be monitored regularly during chemotherapy for evidence of HBV reactivation.
The optimal monitoring schedule for these patients has not yet been ascertained. However it seems logical to perform regular measurement of HBsAb, HBsAg titers and HBV DNA after each cycle of chemotherapy since changes in these parameters are likely to precede changes in ALT and the development of clinically important hepatitis; this would allow antiviral treatment to be commenced in a timely fashion. Recipients of hematopoietic stem cell transplants Selumetinib nmr positive for HBcAb are likely to undergo seroreversion; they are then at risk of HBV reactivation. These patients should probably be treated with prophylactic lamivudine, as for the HBsAg-positive patients. Chemotherapy-induced reactivation of hepatitis B may result in severe liver injury and prevent completion of life-saving treatment of the underlying malignancy. This potentially fatal complication can be effectively prevented by the use of oral antiviral medication prior to commencing
chemotherapy. It is therefore paramount that all patients receiving intensive chemotherapy be screened for HBV. Most of the experience with antivirals in this setting has centered on lamivudine. Although drug resistance is a problem with long-term use of this drug, it has proven to Liothyronine Sodium be safe, well tolerated and highly effective in preventing HBV reactivation. All those involved in the use of immunosuppressive chemotherapy should be aware of the risk of HBV reactivation and understand the principles of prevention or management of this condition. Finally, it is very likely that alternative antiviral agents such as entecavir and tenofovir, will prove at least as effective as lamivudine however, they are currently more expensive and there is a need for further research to confirm their cost-efficacy in this setting. “
“The hemodynamics of patients with portal hypertension within 4 h after a single injection of terlipressin has been studied. However, the hemodynamics in a longer phase under different infusion styles is unknown.