Spontaneous Clearance of Hepatitis B Surface Antigenemia After Long‐term Hemodialysis

Abstract

Persistent infection with the hepatitis B virus (HBV) [as indicated by chronic HBV surface antigenemia (HBsAg)] continues to be an important problem in end-stage renal disease (ESRD) patients and specifically in those receiving maintenance hemodialysis (HD). Patients on HD who are HBsAg-positive for a year have little chance of ever eliminating the virus; hence, clearance of HBsAg is a rare event in long-term HD patients. We report the case of a 62-year-old diabetic woman who was HBsAg-positive at the time she started HD and remained so until 10 years later when she became HBsAg-negative followed by the development of hepatitis B surface antibody (anti-HBs). Prior to her seroconversion, she suffered a persistent infection of her HD arteriovenous graft (AVG) that required prolonged antibiotics and several surgical procedures. We speculate that this immune stimulation contributed to her seroconversion.

Outcomes of hepatitis B surface antigenaemia in patients with incident end‐stage renal disease

“…HBsAg particles, and possibly also Dane particles, are found in ascitic fluid and the outflow dialysate after PD. 30 Patel et al 31 hypothesized that a prolonged arteriovenous graft infection results in substantial tumour necrosis factor-alpha secretion, which reduces regulatory T cellmediated suppression of the anti-HBV response, thus helping the patient clear a chronic HBV infection. This study had several limitations.…”

Spontaneous hepatitis B surface antigen seroconversion after long lasting hepatitis B virus infection in a chronic hemodialysis patient

“…Prior to her seroconversion, she suffered a persistent infection of her HD arteriovenous graft that required prolonged antibiotic therapy and several surgical procedures. Their theory was that seroconversion was the result of a sufficient immune stimulation to allow successful seroconversion 11 . In our case the pa-http://hrcak.srce.hr/medicina are HBsAg-negative.…”