Hepatitis B Virus Belated Reverse Sero-conversion After Hematopoietic Stem Cell Transplantation or Rituximab Chemotherapy

Abstract

Recovery and immunity to hepatitis B virus (HBV) are marked by antibody to hepatitis B core antigen (anti-HBc) with or without antibody to hepatitis B surface antigen (anti-HBs) in the absence of hepatitis B surface antigen (HBsAg). In the profoundly immune compromised individual, HBV may reactivate even in the presence of serologic evidence of resolved infection. The loss of anti-HBs followed by reactivation with development of HBsAg is known as reverse sero-conversion. A 62-year-old female patient with the diagnosis of IgG type of multiple myeloma had received bortezomib-based chemotherapy, and autologous hematopoietic stem cell transplantation (HSCT) was performed thereafter. A 56-year-old male patient with the diagnosis of chronic lymphocytic leukemia had received 6 cures of rituximab-endoxan chemotherapy. Prior to chemotherapy, HBsAg was negative, anti-HBs positive, anti-HBc positive and HBV-DNA was negative in both patients. Approximately one year after chemotherapy, HBV reverse sero-conversion developed in both patients. Resolved HBV infection with undetectable HBV-DNA before chemotherapy or HSCT did not confer HBV reverse sero-conversion. Prior to the creation of regular follow-up or prophylaxis schemes of patients with resolved HBV infection, in whom immune suppressive and anti-cancer treatments or HSCT will be performed, close follow-up of patients for HBV reverse sero-conversion even in late stages after immune suppressive and anti-cancer treatments or HSCT seems beneficial, especially in regions with intermediate or high endemicity for HBV.