Permanent loss of anti-HBc after reactivation of hepatitis B virus infection in an anti-HBs and anti-HBc-positive patient after allogeneic stem cell transplantation

Гартнер, Барбара; Jung, Wolfram; Welsch, Christoph; Fischinger, Johannes; Schubert, Jörg; Zeuzem, Stefan; Mueller‐Lantzsch, Nikolaus; Wend, Ulrike C.; Gerlich, Wolfram H.

doi:10.1016/j.jcv.2006.03.014

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…After stem cell transplantation, it may even lead to a kind of immunotolerance with loss of anti-HBc [25] . It can be fatal, however, after immune reconstitution.…”

Section: Reactivation Of Obi Under Immunosuppressionmentioning

confidence: 99%

Occult Hepatitis B Virus Infection: Detection and Significance

Gerlich

Bremer²,

Saniewski³

et al. 2010

Dig Dis

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The Taormina Consensus Conference defined ‘occult hepatitis B virus (HBV) infection’ (OBI) as the ‘presence of HBV DNA in the liver of individuals testing HBsAg-negative with currently available assays’. Most occult is the so-called ‘window period’ after exposure before HBV DNA appears in the blood. We identified two blood donors whose donations tested HBsAg- and HBV DNA-negative, but transmitted HBV. Both subsequently developed HBsAg and acute hepatitis. However, such cases are not considered as true OBI. A true transient OBI remains HBsAg-negative during the entire course. One case of acute OBI showed a peak viremia of 15,000 IU/ml HBV DNA and sub-borderline HBsAg, suggesting a ratio of virions to subviral particles of 1:10, whereas ‘normal’ cases show at peak viremia a ratio of 1:3,000. Blood donors with OBI may transmit HBV. We studied 5 blood donors with OBI and 55 of their recipients. In 22 recipients, transmission was probable, but they remained healthy. However, in 3 recipients, who were immunosuppressed at the time of transfusion, fatal fulminant hepatitis B developed. The majority of anti-HBc-positive healthy individuals have HBV DNA in the liver which may start replication under severe immunosuppression. Nine such cases are described here. OBI or reactivated HBV infections often lead to selection of HBsAg escape mutations as we could show in 11 of 14 cases. Infection of vaccinated individuals favors development of OBI as we observed in 6 blood donors. HB vaccination may solve the problem of overt HBV infection but may favor OBI.

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“…After stem cell transplantation, it may even lead to a kind of immunotolerance with loss of anti-HBc [25] . It can be fatal, however, after immune reconstitution.…”

Section: Reactivation Of Obi Under Immunosuppressionmentioning

confidence: 99%

Occult Hepatitis B Virus Infection: Detection and Significance

Gerlich

Bremer²,

Saniewski³

et al. 2010

Dig Dis

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“…Negative anti-HBc results in chronically infected patients with some type of immunodeficiency have been repeatedly reported. [2][3][4][5][6][7] However, in 13 such patients of our cohort no immunodeficiency was known. Analogous results have been reported by others for two blood donors.…”

Section: Discussionmentioning

confidence: 85%

“…[2][3][4][5][6][7] In rare cases, HBV carriers are not positive in anti-HBc assays, although no immunodeficiency is known. 8 Many immune assays use a competitive format whereby the patient's anti-HBc blocks the binding of a labelled anti-HBc to HBcAg.…”

Section: Introductionmentioning

confidence: 99%

Re-evaluation of anti-HBc non-reactive serum samples from patients with persistent hepatitis B infection by immune precipitation with labelled HBV core antigen

Kantelhardt

Schwarz

Wend

et al. 2009

Journal of Clinical Virology

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“…These are the main reasons why an active search for viral hepatitis/HIV coinfection by pediatricians caring for HIVinfected children is warranted. Interestingly but also worrisome for pediatricians, occult hepatitis may also be implicated in MTCT (73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85).…”

mentioning

confidence: 99%

“…On the other hand, four patients were both anti-HBc and anti-HBs positive, a serological pattern that traditionally has been associated with immunity due to past infection. However, when immunosuppression occurs, this interpretation warrants consideration because although very uncommon, there is an increased risk of fulminant liver failure if reactivation occurs, so in this case anti-HBs positivity might not exclude OBI definitely (see Figure 17) (76,83,147,(154)(155)(156)(157) .…”

mentioning

confidence: 99%