Gemcitabine and reactivation of hepatitis B.

Patients with chronic hepatitis B are at risk of reactivation of viral hepatitis during chemotherapy. We report a case of hepatitis B reactivation occurring in association with single-agent gemcitabine chemotherapy in the absence of significant myelosuppression. Gemcitabine is a nucleoside analog that can affect cell-mediated immunity, and this may contribute to an increased risk of reactivation of hepatitis B. We advise caution when administering chemotherapy to patients who are hepatitis B surface antigen positive, even when using relatively nontoxic palliative single-agent cytotoxic drugs. Monitoring of liver function tests will identify hepatitis, and measurement of hepatitis B DNA levels may help distinguish chemotherapy-induced hepatitis from hepatitis B virus reactivation.