CLINICAL REACTIVATION OF HEPATITIS B IN ANTI-HBs-POSITIVE PATIENTS WITH AIDS

“…HBV reactivation has been reported during cancer chemotherapy, during HIV infection, and after kidney and bone marrow transplantation (5,7,20,22). There are at least 2 reported cases of HBV reactivation with liver inflammation after rituximab administration, and one patient died When a patient is diagnosed to be reactive for "anti-HBc alone," several explanations might apply to this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Novel Double-Antigen Sandwich Immunoassay for Human Hepatitis B Core Antibody

Yuan

Huang

et al. 2010

Clin Vaccine Immunol

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A novel diagnostic immunoassay testing procedure for hepatitis B virus core antibody (anti-HBc) using homogeneous purified full-length hepatitis B virus core antigen (HBcAg) capsids obtained from Escherichia coli was compared with Abbott Architect anti-HBc chemiluminescent microparticle immunoassay (CMIA; indirect method) against a library of specimens. A monoclonal anti-HBc neutralization confirmatory assay was then used to determine the degree of discordance between specimens. The new assay was found to be superior in both sensitivity and specificity.Antibodies (anti-HBc) to hepatitis B virus (HBV) core antigen (HBcAg) are present in current and past HBV infections. Anti-HBc antibodies represent a long-term serological marker of HBV infection, initially appearing during the acute phase of the infection and generally persisting thereafter (16). Thus, as anti-HBc is a universal marker of HBV infection, routine blood donor screening for anti-HBc has been implemented in some countries with low endemicity. It is a cost-effective method of screening. Such screening procedures have resulted in a decrease in the risk of posttransfusion HBV infections (12). In some individuals, the only serological marker of HBV infection is the presence of anti-HBc antibodies (10, 24), and thus detection of "anti-HBcAg alone" could reflect unrecognized "occult" HBV infection and physicians should consider investigating such patients with HBV molecular tests (21). Additionally, isolated anti-HBc can be used as a marker to assess the risk of HBV reactivation in patients undergoing therapy that could result in immunosuppression or patients who are HIV positive (17) or hepatitis C virus (HCV) positive (25).With these uses in mind, having a more efficient and reliable assay for anti-HBc is desirable. Most current commercially available anti-HBc assays have poor sensitivity or specificity (2, 19) and can be attributed to the inferior performance of the competitive immunoassay, especially for detecting low-titer antiHBc-reactive samples. False-positive reactivity can partially be attributed to unspecific activation of premature B lymphocytes causing the production of IgM, IgA, or IgM-related molecules without previous exposure to HBV (18,19). The specificity of competitive assays for anti-HBc can be significantly improved by addition of mild reducing agents, but such modified procedures often lead to the loss of sensitivity, particularly for IgM anti-HBc (23). In this study, a novel immunoassay for anti-HBc based on the double-antigen sandwich enzyme-linked immunosorbent assay (ELISA) method is compared with a commercial anti-HBc assay, the Architect chemiluminescent microparticle immunoassay (CMIA). MATERIALS AND METHODSExpression and purification of full-length rHBcAg in E. coli. Two full-length HBcAg genes were obtained by chemosynthesis: AB090269 (genotype D, named CpD) and AB014368 (genotype C, named CpC). The rare arginine codes in Escherichia coli (AGA and AGG) located in the HBcAg gene were changed to CGT. The two fragments were inse...

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“…In patients with past infection (antiHBs and anti-HBc positive), HBV reactivation has been reported during chemotherapy, HIV infection, and after kidney and bone marrow transplantation [14][15][16][17] . In the present study, HBV reactivation with reappearance of HBsAg was observed in one "anti-HBc alone" patient after treatment with rituximab (humanized monoclonal antibody to CD 20) and chemotherapy for non-Hodgkin lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

Knöll¹

2006

WJG

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AIM:To investigate the prevalence and clinical significance of "anti-HBc alone" in an unselected population of patients and employees of a university hospital in southern Germany. METHODS:All individuals with the pattern "anti-HBc alone" were registered over a time span of 82 mo. HBV-DNA was measured in serum and liver samples, and clinical charts were reviewed. RESULTS:Five hundred and fifty two individuals were "anti-HBc alone" (of 3004 anti-HBc positive individuals; 18.4%), and this pattern affected males (20.5%) more often than females (15.3%; P < 0.001). HBV-DNA was detected in serum of 44 of 545 "anti-HBc alone" individuals (8.1%), and in paraffin embedded liver tissue in 16 of 39 patients tested (41.0%). There was no association between the detection of HBV genomes and the presence of biochemical, ultrasonic or histological signs of liver damage. Thirty-eight "anti-HBc alone" patients with cirrhosis or primary liver carcinoma had at least one additional risk factor. HCV-coinfection was present in 20.4% of all individuals with "anti-HBc alone" and was the only factor associated with a worse clinical outcome. CONCLUSION:In an HBV low prevalence area, no evidence is found that HBV alone causes severe liver damage in individuals with "anti-HBc alone". Recommendations for the management of these individuals are given.

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CLINICAL REACTIVATION OF HEPATITIS B IN ANTI-HBs-POSITIVE PATIENTS WITH AIDS

Cited by 75 publications

References 9 publications

Significant rate of hepatitis B reactivation following kidney transplantation in patients with resolved infection

Significant rate of hepatitis B reactivation following kidney transplantation in patients with resolved infection

Novel Double-Antigen Sandwich Immunoassay for Human Hepatitis B Core Antibody

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

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