Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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Abstracts / Journal of Clinical Virology 82S (2016) S1–S142 S73
Abstract no: 251
Presentation at ESCV 2016: Poster 105
Reactivation of hepatitis B virus infection with
pazopanib: Lessons for all in caring for
co-morbid patients
B. Poller ∗, B. Kawar , M. Raza
1 Virology, Sheffield Teaching Hospitals, Sheffield, UK
2 Sheffield Kidney Institute, Sheffield Teaching
Hospitals, UK
In an era of emerging immunosuppressive treatments for
inflammatory and malignant conditions, hepatitis B virus
reactivation (HBVr) is now a well described yet rare compli-
cation. From mild derangement of liver function to fulminant
liver failure, clinicians must be aware of the risk. Pre-treatment
screening can highlight those requiring prophylaxis or monitoring.
We present a first case report of reactivation of resolved HBV
(surface antibody [anti-HBs] negative, core-antibody [anti-HBc]
positive), in a patient on pazopanib, a multi-tyrosine kinase
inhibitor used in advanced renal cell carcinoma; a challenging case
for all involved.
The patient was a Chinese male who began treatment in
December 2015. He had undergone haemodialysis for over a year,
screened according to local guidelines for hepatitis B surface anti-
gen (HBsAg) 3 monthly and anti-HBs yearly (both undetected).
Anti-HBc was not checked pre-pazopanib. A quarterly dialysis
screen taken 8 weeks after starting pazopanib found low level
HBsAg. This coincided with an assay issue causing false positive
HBsAg results; significance of the result could have beenmissed but
his ethnicity anddialysis status led to urgent confirmatory tests that
showed low level HBV DNA. Testing of old stored samples showed
resolved infection, with no evidence of HBVr on his dialysis screen 4
weeks pre-pazopanib, and no samples since to time the reactivation
further. The patient had developed a transaminitis over the month
prior to HBVr diagnosis, with pazopanib stopped by his oncologist.
It is well known to increase transaminases; the patient was also
taking pravastatin, further increasing the risk t was fortunate
his routine dialysis HBV screen occurred at that time, since his liver
function improved after stopping pazopanib and HBVr may have
gone undetected.
HBVr in this patient had wider implications than just his health,
as he was dialysing in an open ward until the diagnosis, and sig-
nificant work required to follow up dialysis contacts. Fortunately
the reactivated virus remained at low levels and no secondary HBV
infections have occurred to date. Low level HBsAg is still detected
although viral load is now undetectable and liver function recov-
ered.
This case highlights the importance of HBV screening pre-
immunosuppression, the need for clinicians to be aware of the risks
of new therapies, and timely investigation and liaison between spe-
cialties in suspected adverse events. In Sheffield our oncologists
do not routinely screen pre-treatment, also experienced elsewhere
If past HBV was known, monthly screening would have been
advised by local guidelines, and HBVr may have been detected ear-
lier. Although pazopanib is not as high risk as some drugs, we are
nowaware thatmost immunosuppressive therapies have some risk
of HBVr. With many new agents available, it is no longer just the
prescribers that need to be aware of their complications, although
focus on increasing screening by oncologists in particular, appears
internationally to be the first step to protect such patients, and
potentially others.
Reference
[1] C.F. Xu, Z. Xue, N. Bing, K.S. King, L.A. McCann, P.L. de Souza, et al., Concomitant
use of pazopanib and simvastatin increases the risk of transaminase elevations
in patients with cancer, Ann. Oncol. 23 (9) (2012) 2470–2471.
[2] S.A. Gonzalez, R.P. Perrillo, B. Hepatitis, Virus reactivation in the setting of
cancer chemotherapy and other immunosuppressive, Drug Therapy Clin.
Infect. Dis. 62 (Suppl. 4) (2016) S306–S313.
Abstract no: 257
Presentation at ESCV 2016: Poster 106
Enhancing the screening of active hepatitis C
virus (HCV) infection through molecular testing
of dried-blood spots in a community-based
counselling and testing centre in Barcelona
V. Saludes ∗, C. Folch , A. Morales-Carmona ,
L. Ferrer , L. Fernández , R. Mu˜noz ,
M. Jiménez , E. Loureiro , P. Fernández-Dávila ,
E. Bascu˜nana , J. Casabona , E. Martró
1 Microbiology Service, Germans Trias i Pujol
University Hospital, Germans Trias i Pujol Health
Sciences Research Institute (IGTP), Badalona, Spain
2 Centro de Investigación Biomédica en Red (CIBER)
en Epidemiología y Salud Pública (CIBERESP), Spain
3 Centre d’Estudis Epidemiològics sobre les Infeccions
de Transmissió Sexual i Sida de Catalunya
(CEEISCAT), Agencia de Salut Publica de Catalunya
(ASPC), Spain
4 Research Department, Stop Sida, Barcelona, Spain
Background: More than half of HCV-infected individuals are
unaware of their disease, leading to transmission and liver dis-
ease progression. Promoting HCV screening is a global priority, but
the conventional testing algorithm (serology followed by molecu-
lar confirmatory testing) does not facilitate the diagnosis of active
infection, especially in hard-to-reach populations at risk. Thus, the
use of alternative strategies is essential. HCV infection has emerged
as a sexually-transmitted infection (STI) among HIV-infected men
who have sex with men (MSM), but data in Spain on HIV-negative
MSM as well as male sex workers (MSW) and transsexual women
sex workers (TSW) is scarce.
Objectives: We aimed to set up a molecular assay able to
detect the HCV-RNA in dried blood spots (DBS), and to assess
its implementation and usefulness in comparison with antibody
point-of-care testing in a community-based counselling and test-
ing centre in Barcelona, in order to improve the early diagnosis of
active HCV infection among MSM, MSW and TSW.
Methodology: A duplex real-time RT-PCR assay for the detec-
tion of the HCV-RNA and an internal control in DBS was set
up, and its analytical and clinical performance was assessed. The
acceptability, feasibility, and yield of HCV testing at this centre
were assessed in comparison with OraQuick HCV Rapid Antibody
testover one year. Epidemiological and behavioural data related to
HCV infection were collected.
Results: The molecular assay showed a lower limit of detec-
tion of 541 IU/mL, and was precise and reproducible. DBS were
demonstrated to be stable at room temperature for at least 2
months. The assay was 100% sensitive and specific in comparison
with our frontline viral load assay (Abbott Molecular). Acceptabil-
ity of HCV testing was very high (95.4%) among the 631 individuals
approached. Four MSM were excluded as they had a previous HCV
diagnosis (0.64% self-reported seroprevalence), and another four
were underage. Among the 594 participants, 73.6% were MSM,