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Viral Immunol. 2019 Dec 26. doi: 10.1089/vim.2019.0119. [Epub ahead of print]
Hepatitis B Surface Antigen Seroconversion by Interferon-α2b Combined with Granulocyte-Macrophage Colony-Stimulating Factor and Hepatitis B Vaccine: A Case Report.
Li S1, Luo S2, Lei Q2, Meng Z2,3.
Author information
1
Department of Infectious Diseases, Yunyang Branch of Taihe Hospital, Hubei University of Medicine, Shiyan, China.
2
Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
3
Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
Abstract
Hepatitis B surface antigen (HBsAg) loss and/or seroconversion is the ideal endpoint for the treatment of patients with chronic hepatitis B (CHB), whereas the "functional cure" of hepatitis B virus (HBV) infection is hard to obtain with routine therapeutics. Thus, potential new strategies are explored to cure HBV infection. A combination immunomodulatory therapeutic regime was used in a 43-year-old female patient with hepatitis B e antigen (HBeAg)-negative CHB; the regimen included consecutive combination therapy with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) plus HBV vaccine, in addition to ongoing normal interferon (IFN)-α2b treatment. The serum levels of alanine aminotransferase (ALT), HBV DNA, HBsAg, and hepatitis B surface antibody (HBsAb) were monitored every 6 months. The ALT level normalized and HBV DNA decreased to a level below the limit of detection within 3 months after the initiation of IFN-α2b therapy. After an entire year of IFN treatment, serum HBsAg decreased to a very low level (3.16 IU/mL), and HBsAb was still negative (0.78 mIU/mL). Then, rhGM-CSF and the HBV vaccine were applied, in addition to continuous IFN therapy. A steady decline in HBsAg was observed, and HBsAg loss with HBsAb seroconversion was achieved 12 months after initiation of the combination treatment with rhGM-CSF and HBV vaccine; the IFN-α2b was discontinued for the later 6 months. A therapeutic regimen with GM-CSF plus HBV vaccine could keep the immune system actively stimulated and trigger an HBV-specific immune response to control, or even clear the virus; this regimen may be helpful in the "cure" of HBV infection when combined with IFN-α.
KEYWORDS:
HBV vaccine; chronic hepatitis B; hepatitis B surface antigen; interferon; recombinant granulocyte–macrophage colony-stimulating factor
PMID:
31880508
DOI:
10.1089/vim.2019.0119
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