隐匿性乙肝病毒感染的细胞毒性淋巴瘤治疗后抗-HBc阴性的患

StephenW

Source: J Med Virol  |  Posted 6 days ago
Reactivation of occult hepatitis B virus infection following cytotoxic lymphoma therapy in an anti-HBc negative patient; Feeney SA, McCaughey C, Watt AP, Agnaf MR, McDougall N, Wend UC, Gerlich WH, Coyle PV; Journal of Medical Virology (Jan 2013)


Screening hepatitis B virus (HBV) surface antigen (HBsAg) and HBV core antibody (anti-HBc) is recommended prior to cytotoxic or immunosuppressive therapy. This case describes an anti-HBc negative, DNA positive occult HBV infection in a 71-year-old Caucasian male following rituximab-based treatment for follicular lymphoma. Pre-screening serology indicated negative HBsAg and anti-HBc. However, following sequential treatment cycles the patient developed weak HBsAg with a low HBV DNA load (<1,000 IU/ml), but remained anti-HBc negative. The DNA load peaked 5 months later (>1 × 10(6)  IU/ml) and he was subsequently treated with Tenofovir. Currently the patient remains anti-HBc negative, and is anti-HBe negative, anti-HBs negative, HBeAg positive. No clinical or biochemical evidence of hepatitis has occurred. Sequencing and phylogenetic analysis identified the HBV genosubtype as D4, most probably acquired some years ago during a stay in Papua New Guinea, in spite of prior hepatitis B vaccination. Four amino acid substitutions were detected within the HBsAg loop yet none in the core protein. This case questions the dependability of anti-HBc testing and highlights the role of HBV DNA testing prior to and throughout cytotoxic or immunosuppressive regimes. As this case exemplifies, vaccination protects against clinical infection but may not exclude seronegative occult infection with the possibility of reactivation. J. Med. Virol. © 2013 Wiley Periodicals, Inc.

StephenW

筛选B型肝炎病毒（HBV）表面抗原（HBsAg）和HBV核心抗体（抗-HBc）建议之前，细胞毒性或免疫抑制治疗。这种情况说明抗-HBc阴性，DNA阳性的隐匿性HBV感染的一个71岁的白人男性，下面的利妥昔单抗为基础的治疗滤泡性淋巴瘤。预检血清学HBsAg阴性，抗-HBc表示。然而，随着连续的治疗周期，病人出现低HBV DNA载量（<1,000 IU/ ml）的弱乙肝表面抗原，但仍保持抗-HBc阴性。 5个月后DNA载量达到高峰（> 1×10（6）IU /毫升），他随后用替诺福韦。目前患者仍是抗-HBc阴性，抗-HBe阴性，抗-HBs阴性，HBeAg阳性。无临床或生化证据肝炎的发生。测序和系统进化分析确定了HBV genosubtype，D4，最有可能收购若干年前在逗留期间在巴布亚新几内亚，尽管事先接种乙肝疫苗。内检测到的核心蛋白的HBsAg环路尚未没有在四个氨基酸取代。这种情况下，抗-HBc检测的可靠性提出质疑，并强调前HBV DNA检测的作用和整个细胞毒性或免疫制度。这种情况下，充分体现了对临床感染，接种疫苗保护，但不排除阴性的隐匿性感染与激活的可能性。 J.医学。病毒学2013年威利，