Vaccinating against hepatitis B virus (HBV) infection reduces the risk of non-Hodgkin lymphoma (NHL) in adolescents, according to a study published in the Journal of Viral Hepatitis.
In Taiwan, while universal HBV vaccination drastically reduced the prevalence of HBV in children, HBV infection remains common in adults. Chronic HBV infection often leads to chronic inflammation and stimulation of lymphocytes. While epidemiological data suggest that HBV infection is a risk factor for NHL, data are lacking regarding the effect of HBV vaccination on the risk of NHL.
Researchers evaluated the relationship between HBV infection, HBV vaccination, and the risk of NHL in the Taiwanese population using the National Health Insurance Research Database.
A total of 38,628 individuals with HBV infection and 944,609 individuals without HBV infection were included in the study.
Compared with individuals without HBV infection, individuals with HBV infection were more than 4 times as likely to develop NHL and more than 5 times as likely to have CD20+ aggressive NHL. Increasing age was also identified as an independent risk factor for NHL.
Individuals with HBV infection had a significantly higher incidence rates of NHL (17.07 vs 3.75 per 100,000 person-years; P <.0001) and CD20+ aggressive NHL (13.9 vs 2.14 per 100,000 person-years; P <.0001) than individuals without HBV infection.
Of the study population, 272,975 individuals were born during the time of universal HBV vaccination (after July 1984). Between the age of 12.5 and 20, the incidence of NHL was significantly higher in individuals born before 1984 than in individuals born after 1984 (1.85 vs 0.74 per 100,000 person-years; P =.0328). But no difference in NHL incidence was observed between the before-1984 and after-1984 groups for age 21 to 29.5.
In patients with a history of HBV infection, individuals who received treatment for HBV (n=4069) were significantly less likely to develop NHL than individuals who did not receive treatment for HBV (n=34,559; 0.07% vs 0.31%; P =.0076). No patient treated for HBV developed CD20+ aggressive lymphoma, which occurred in 52 (0.15%) patients not treated for HBV.
“In conclusion, this large cohort study confirms the risk of HBV infection for developing NHL and CD20+ aggressive lymphoma. Our study demonstrates, for the first time, universal HBV vaccination reduces the incidence of NHL in adolescent and young adults less than 20 years. It suggests that cancer prevention through HBV vaccination is not only for hepatocellular carcinoma but also NHL in endemic areas of HBV infection. However, this needs a longer period of follow-up for confirmation in older populations,” the researchers wrote.
“These evidences suggest that HBV could be an etiologic factor for NHL and CD20+ aggressive lymphoma, although confirmation of the mechanism needs further study,” they added.
Huang CE, Yang YH, Chen YY, et al. The impact of hepatitis B virus infection and vaccination on the development of non-Hodgkin lymphoma [published online April 4, 2017]. J Viral Hepat. doi:10.1111/jvh.12713