1. bookVolume 29 (2021): Issue 1 (January 2021)
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08 Aug 2013
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© 2020 Sciendo

Rapid loss of HBs antigen in patients with HBV reactivation and high level of transaminases during immunosuppressive therapy - case series

Published Online: 29 Jan 2021
Page range: 105 - 113
Received: 24 Jul 2020
Accepted: 05 Nov 2020
Journal Details
License
Format
Journal
First Published
08 Aug 2013
Publication timeframe
4 times per year
Languages
English
Copyright
© 2020 Sciendo
Abstract

Reactivation of hepatitis B virus (HBV) infection has been described in patients with HBsAg negative and antiHBc positive (occult hepatitis B infection -OBI) receiving immunosuppressive therapy (IST). The lack of proper monitoring of patients with this HBV infection during IST can result in viral reactivations with high level of transaminases, jaundice and even acute liver failure. In these situations, it is mandatory to start antiviral therapy with nucleot(s) ide analogs (NA) which produce a strong viral suppression. We report a series of five cases of OBI patients with severe HBV reactivation during IST. One patient was diagnosed with hematologic malignancy (non-Hodgkin lymphoma), two with rheumatoid arthritis, one with psoriasis and one patient with renal transplant. All the patients were evaluated and treated for the reactivation of HBV in the Prof. Dr. Matei Bals National Institute of Infectious Diseases, a tertiary care hospital from Bucharest, Romania. At the time of HBV reactivation diagnosis, 3 patients were asymptomatic and two developed jaundice. All had acute ALT flares (more than 10 times the upper limit of normal range - ULN), very high HBV viral loads and anti-HBc serum IgM antibodies. All patients were immediately treated with ETV 0.5 mg/day and if it was possible, IST was stopped. In all cases was obtained quickly HBsAg loss under antiviral therapy.

1. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute Technical Review on Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy. Gastroenterology. 2015 Jan 1;148(1):221–244.e3. DOI: 10.1053/j.gastro.2014.10.038Search in Google Scholar

2. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98.Search in Google Scholar

3. Terrault NA, Lok ASF, McMahon BJ, Chang K-M, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatol Baltim Md. 2018;67(4):1560–99. DOI: 10.1002/hep.29800Search in Google Scholar

4. Davis GL, Hoofnagle JH, Waggoner JG. Spontaneous reactivation of chronic hepatitis B virus infection. Gastroenterology. 1984 Feb;86(2):230–5. DOI: 10.1016/0016-5085(84)90406-2Search in Google Scholar

5. Fattovich G, Brollo L, Alberti A, Realdi G, Pontisso P, Giustina G, et al. Spontaneous reactivation of hepatitis B virus infection in patients with chronic type B hepatitis. Liver. 1990 Jun;10(3):141–6. DOI: 10.1111/j.1600-0676.1990.tb00449.xSearch in Google Scholar

6. Puri P. Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B. J Clin Exp Hepatol. 2013 Dec;3(4):301–12. DOI: 10.1016/j.jceh.2013.08.014Search in Google Scholar

7. Kazemi-Shirazi L, Petermann D, Müller C. Hepatitis B virus DNA in sera and liver tissue of HBsAg negative patients with chronic hepatitis C. J Hepatol. 2000 Nov;33(5):785–90. DOI: 10.1016/S0168-8278(00)80311-6Search in Google Scholar

8. Yuen MF, Lee C, Wong D, Fung J, Hung I, Hsu A, 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 Oct 1;59:1389–93. DOI: 10.1136/gut.2010.209148Search in Google Scholar

9. Raimondo G, Locarnini S, Pollicino T, Levrero M, Zoulim F, Lok AS, et al. Update of the statements on biology and clinical impact of occult hepatitis B virus infection. J Hepatol. 2019 Aug;71(2):397–408. DOI: 10.1016/j.jhep.2019.03.034Search in Google Scholar

10. Makvandi M. Update on occult hepatitis B virus infection. World J Gastroenterol. 2016 Oct 21;22(39):8720–34. DOI: 10.3748/wjg.v22.i39.8720Search in Google Scholar

11. Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies and future directions. Gastroenterology. 2017 May;152(6):1297–309. DOI: 10.1053/j.gastro.2017.02.009Search in Google Scholar

12. Villadolid J, Laplant KD, Markham MJ, Nelson DR, George TJ. Hepatitis B reactivation and rituximab in the oncology practice. The Oncologist. 2010;15(10):1113–21. DOI: 10.1634/theoncologist.2010-0106Search in Google Scholar

13. Muraishi J, Shibata M, Honma Y, Hiura M, Abe S, Harada M. Reactivation of Occult Hepatitis B Virus Infection 27 Months after the End of Chemotherapy Including Rituximab for Malignant Lymphoma. Intern Med Tokyo Jpn. 2017;56(15):1967–71. DOI: 10.2169/internalmedicine.56.8233Search in Google Scholar

14. Tsutsumi Y, Yamamoto Y, Ito S, Ohigashi H, Shiratori S, Naruse H, et al. Hepatitis B virus reactivation with a rituximab-containing regimen. World J Hepatol. 2015 Sep 28;7(21):2344–51. DOI: 10.4254/wjh.v7.i21.2344Search in Google Scholar

15. Sagnelli C, Pisaturo M, Calò F, Martini S, Sagnelli E, Coppola N. Reactivation of hepatitis B virus infection in patients with hemo-lymphoproliferative diseases, and its prevention. World J Gastroenterol. 2019 Jul 14;25(26):3299–312. DOI: 10.3748/wjg.v25.i26.3299Search in Google Scholar

16. Kim GA, Lim YS, An J, Lee D, Shim JH, Kim KM, et al. HBsAg seroclearance after nucleoside analogue therapy in patients with chronic hepatitis B: clinical outcomes and durability. Gut. 2014 Aug;63(8):1325–32. DOI: 10.1136/gutjnl-2013-305517Search in Google Scholar

17. Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, et al. A randomized trial of combination hepatitis B therapy in HIV/HBV coinfected antiretroviral naïve individuals in Thailand. Hepatology. 2008;48(4):1062–9. DOI: 10.1002/hep.22462Search in Google Scholar

18. Ueda Y, Marusawa H, Ichinohe T, Kadowaki N, Uchiyama T, Chiba T. Effective treatment for de novo hepatitis B with nucleotide analogue in patients with hematological malignancies. Am J Hematol. 2009 May;84(5):315–6. DOI: 10.1002/ajh.21388Search in Google Scholar

19. Sanchez MJ, Buti M, Homs M, Palacios A, Rodriguez-Frias F, Esteban R. Successful use of entecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab. J Hepatol. 2009 Dec 1;51(6):1091–6. DOI: 10.1016/j. jhep.2009.07.012Search in Google Scholar

20. Brost S, Schnitzler P, Stremmel W, Eisenbach C. Entecavir as treatment for reactivation of hepatitis B in immunosuppressed patients. World J Gastroenterol WJG. 2010 Nov 21;16(43):5447–51. DOI: 10.3748/wjg.v16. i43.5447Search in Google Scholar

21. Nagaoka S, Abiru S, Komori A, Sasaki R, Bekki S, Hashimoto S, et al. Hepatic flares promote rapid decline of serum hepatitis B surface antigen (HBsAg) in patients with HBsAg seroclearance: A long-term follow-up study. Hepatol Res. 2016;46(3):E89–99. DOI: 10.1111/hepr.12533Search in Google Scholar

22. Buti M, Riveiro-Barciela M, Esteban R. Long-term safety and efficacy of nucleo(t)side analogue therapy in hepatitis B. Liver Int. 2018;38(S1):84–9. DOI: 10.1111/liv.13641Search in Google Scholar

23. Popescu C, Lobodan A, Rădulescu M, Negru A, Molagic V, Hristea A, et al. Treatment of chronic HBV hepatitis - between immune control and virological control. BMC Infect Dis. 2014 Oct 15;14(7):O10. DOI: 10.1186/1471-2334-14-S7-O10Search in Google Scholar

24. Aydemir S, Yildirmak MT, Sayan M, Atak S, Kucuk M. A chronic hepatitis B patient infected with HBsAg diagnostic-escape strain in the presence of anti-HBs positivity. Rev Romana Med Lab. 2019;27(4):421–6. DOI:10.2478/rrlm-2019-0038Search in Google Scholar

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