Protracted HBsAg-aemia in a Patient with Acute Hepatitis B
https://doi.org/10.22416/1382-4376-2018-28-5-126-133
Abstract
Aim. This clinical observation was aimed at analysing the course of the disease in a patient with a protracted persistence of HBsAg and HBV DNA in the blood in the outcome of acute hepatitis B and the possible formation of a latent HBV infection in the phase of clinical recovery.
General findings. We carried out a 31-month observation study of a patient suffering from acute hepatitis B. Subsequently, we performed a dynamic assessment of the viral kinetics and qualitative and quantitative assessment of HBsAg in the blood using highly sensitive analytical methods. These methods allowed a protracted persistence of HBV DNA in the blood and a late seroconversion of HBsAg/anti-HBs to be revealed.
Conclusion. The described clinical case demonstrates the possibility of an atypically protracted persistence of HBsAg in the outcome of acute hepatitis B, which is followed by a clinical and laboratory picture of recovery and the formation of latent chronic HBV infection, as an example of the 5th phase of chronic HBV infection (HBsAg-negative), according to a new classification, reflected in the clinical guidelines for the treatment of hepatitis B (EASL 2017).
About the Authors
K. R. Dudina
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Department of Infectious Diseases and Epidemiology.
Russian Federation
Russian Federation
Dr. Sci. (Med.), Ass. Prof., Department of Infectious Diseases and Epidemiology, Evdokimov Moscow State University of Medicine and Dentistry.
Moscow, Volokolamskoe highway, 63.
O. O. Znoyko
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Department of Infectious Diseases and Epidemiology.
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Department of Infectious Diseases and Epidemiology, Evdokimov Moscow State University of Medicine and Dentistry.
Moscow, Volokolamskoe highway, 63.
References
1. Hoofnagle J.H., Seeff L.B., Bales Z.B., Zimmerman H.J. Type B hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. N Engl J Med. 1978; 298:1379–83. DOI: 10.1056/nejm197806222982502
2. Hu K.Q. Occult hepatitis B virus infection and its clinical implications. J Viral Hepat. 2002;9:243–57. DOI: 10.1046/j.1365-2893.2002.00344.x
3. Raimondo G., Allain J.P., Brunetto M.R., et al. Statements from the Taormina expert meeting on occult hepatitis B virus infection. J Hepatol. 2008;49:652–57. DOI: 10.1016/j.jhep.2008.07.014
4. Diarra B., Yonli A.T., Sorgho P.A., et al. Occult Hepatitis B Virus Infection and Associated Genotypes among HBsAg-negative Subjects in Burkina Faso. Mediterr J Hematol Infect Dis. 2018;10(1):e2018007. DOI: 10.4084/ MJHID.2018.007
5. Yuen M.F., Lee C.K., Wong D.K., et al. Prevalence of occult hepatitis B infection in a highly endemic area for chronic hepatitis B: a study of a large blood donor population. Gut. 2010;59:1389–93. DOI:10.1136/ gut.2010.209148
6. Bamaga M.S., Sobahy T.M., Attar A.A. Quantitative DNA analysis of very low-level hepatitis B viremic patients reporting to the gastroenterology clinic. Saudi Med J. 2011;32(2):135–40.
7. Raimondo G., Pollicino T., Cacciola I., Squadrito G. Occult hepatitis B virus infection. J Hepatol. 2007;46:160– 70. DOI: 10.1016/j.jhep.2006.10.007
8. Morales-Romero J., Vargas G., García-Román R. Occult HBV infection: a faceless enemy in liver cancer development. Viruses. 2014;6:1590–611. DOI: 10.3390/v6041590
9. Levrero M., Pollicino T., Petersen J., et al. Control of cccDNA function in hepatitis B virus infection. J Hepatol. 2009;51:581–92. DOI: 10.1016/j.jhep.2009.05.022
10. Kay A., Zoulim F. Hepatitis B virus genetic variability and evolution. Virus Res. 2007;127:164–76. DOI: 10.1016/j. virusres.2007.02.021
11. Samal J., Kandpal M., Vivekanandan P. Molecular mechanisms underlying occult hepatitis B virus infection. Clin Microbiol Rev. 2012;25(1):142–63. DOI: 10.1128/ CMR.00018-11
12. Zhu H.L., Li X., Li J., Zhang Z.H. Genetic variation of occult hepatitis B virus infection. World J Gastroenterol. 2016;22(13):3531–46. DOI: 10.3748/wjg.v22.i13.3531
13. Raimondo G., Caccamo G., Filomia R., Pollicino T. Occult HBV infection. Semin Immunopathol. 2013;35:39–52. DOI: 10.1007/s00281-012-0327-7
14. Ahmadabadi B.N., Hassanshahi G., Arababadi M.K., et al. The IL-10 promoter polymorphism at position -592 is correlated with susceptibility to occult HBV infection. Inflammation. 2012;35:818–21. DOI: 10.1007/s10753011-9381-x
15. Makvandi M. Update on occult HBV infection. World J Gastroenterol. 2016;22(39):8720–34. DOI: 10.3748/wjg. v22.i39.8720
16. Torbenson M., Thomas D.L. Occult hepatitis B. Lancet Infect Dis. 2002;2:479–86.
17. Ramezani A., Banifazl M., Eslamifar A., Sofian M., Aghakhani A. Occult hepatitis B infection in different high risk patients. Hepat Mon. 2012;12:467–8. DOI: 10.5812/hepatmon.7094
18. Lada O., Benhamou Y., Poynard T., Thibault V. Coexistence of hepatitis B surface antigen (HBs Ag) and anti-HBs antibodies in chronic hepatitis B virus carriers: influence of “a” determinant variants. J Virol. 2006;80:2968–75. DOI: 10.1128/jvi.80.6.2968-2975.2006
19. Kim H., Lee S.A., Won Y.S., et al. Occult infection related hepatitis B surface antigen variants showing lowered secretion capacity. World J Gastroenterol. 2015;21:1794– 803. DOI: 10.3748/wjg.v21.i6.1794
20. Bläckberg J., Kidd-Ljunggren K. Occult hepatitis B virus after acute self-limited infection persisting for 30 years without sequence variation. J Hepatol. 2000;33:992–7.
21. Durantel D., Zoulim F. New antiviral targets for innovative treatment concepts for hepatitis B virus and hepatitis delta virus. J Hepatol. 2016;64(1 Suppl):S117–31. DOI: 10.1016/j.jhep.2016.02.016
22. Hammond S.P., Borchelt A.M., Ukomadu C., et al. Hepatitis B virus reactivation following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2009;15:1049–59. DOI: 10.1016/j. bbmt.2009.05.001
23. Raimondo G., Pollicino T., Romanò L., Zanetti A.R. A 2010 update on occult hepatitis B infection. Pathol Biol (Paris). 2010;58:254–7. DOI: 10.1016/j.patbio.2010.02.003
24. Pérez-Alvarez R., Díaz-Lagares C., García-Hernández F., et al. Hepatitis B virus (HBV) reactivation in patients receiving tumor necrosis factor (TNF)-targeted therapy: analysis of 257 cases. Medicine (Baltimore). 2011;90:359– 71. DOI: 10.1097/MD.0b013e3182380a76
25. Di Bisceglie A.M., Lok A.S., Martin P., et al. Recent US Food and Drug Administration warnings on hepatitis B reactivation with immune-suppressing and anticancer drugs: just the tip of the iceberg?. Hepatology. 2015;61:703–11. DOI: 10.1002/hep.27609
26. Vivekanandan P., Kannangai R., Ray S.C., et al. Comprehensive genetic and epigenetic analysis of occult hepatitis B from liver tissue samples. Clin Infect Dis. 2008;46(8):1227–36.
27. Kim H., Lee S.A., Kim D.W., et al. Naturally occurring mutations in large surface genes related to occult infection of hepatitis B virus genotype C. PLoS One. 2013;8:e54486. DOI: 10.1371/journal.pone.0054486
28. Yotsuyanagi H., Ito K., Yamada N., et al. High levels of hepatitis B virus after the onset of disease lead to chronic infection in patients with acute hepatitis B. Clin Infect Dis. 2013;57(7):935–42. DOI: 10.1093/cid/cit348
29. Du X., Liu Y., Ma L., et al. Virological and serological features of acute hepatitis B in adults. Medicine (Baltimore). 2017;96(7):e6088. DOI: 10.1097/ MD.0000000000006088
30. Rehermann B., Ferrari C., Pasquinelli C., Chisari F.V. The hepatitis B virus persists for decades after patients’ recovery from acute viral hepatitis despite active maintenance of a cytotoxic T-lymphocyte response. Nat Med. 1996;2:1104–8.
31. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370– 98. DOI: 10.1016/j.jhep.2017.03.021
32. Elrashidy H., El-Didamony G., Elbahrawy A., et al. Absence of occult hepatitis B virus infection in sera of diabetic children and adolescents following hepatitis B vaccination. Hum Vaccin Immunother. 2014;10:2336–41. DOI:10.4161/hv.29521
33. Lai M.W., Lin T.Y., Liang K.H., et al. Hepatitis B viremia in completely immunized individuals negative for anti-hepatitis B core antibody. Medicine (Baltimore). 2016;95(49):e5625. DOI: 10.1097/MD.0000000000005625
34. Powell E.A., Razeghi S., Zucker S., et al. Occult Hepatitis B Virus Infection in a Previously Vaccinated Injection Drug User. Hepat Mon. 2016;16(2):e34758. DOI: 10.5812/hepatmon.34758
35. Chu C.M., Liaw Y.F. HBsAg seroclearance in asymptomatic carriers of high endemic areas: appreciably high rates during a long-term follow-up. Hepatology. 2007;45:1187– 92. DOI: 10.1002/hep.21612
36. McMahon B.J., Holck P., Bulkow L., Snowball M. Serologic and clinical outcomes of 1536 Alaska Natives chronically infected with hepatitis B virus. Ann Intern Med. 2001;135:759–68. DOI: 10.7326/0003-4819-135-9200111060-00006
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For citations:
Dudina K.R., Znoyko O.O. Protracted HBsAg-aemia in a Patient with Acute Hepatitis B. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(5):126-133. (In Russ.) https://doi.org/10.22416/1382-4376-2018-28-5-126-133
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