免疫功能低下儿科患者阳性抗乙型肝炎核心抗体检测的解释

StephenW

Transpl Infect Dis. 2019 Mar 13:e13074. doi: 10.1111/tid.13074. [Epub ahead of print]
Interpretation and management of positive anti-hepatitis B core antibody tests in immunocompromised pediatric patients.
Kitt E1,2, Hayes M3, Cardenas AM2,4, Green AM1,2,5.
Author information

1
    Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
2
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
    Antimicrobial Stewardship Program, The Children's Hospital of Philadelphia, PA.
4
    Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, PA.
5
    Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.

Abstract

Intravenous immunoglobulin (IVIg) therapy is increasingly used in the pediatric population, in particular among children with immune-compromising conditions. Pooled immunoglobulin products are routinely tested for hepatitis B surface antigen (HBsAg) and nucleic acid, however screening for hepatitis B core antibody (anti-HBc) is not commonly performed. Thus, the administration of IVIg containing anti-HBc to children with immune-compromising conditions may complicate the interpretation of hepatitis B serologic testing in that a positive anti-HBc test may represent passive transfer of antibody from IVIg or may indicate resolved or chronic hepatitis B infection. Due to the risk of hepatitis B reactivation in immunocompromised patients, a positive anti-HBc test must be carefully considered. As part of a quality improvement initiative, we identified and reviewed the records of all pediatric patients at our institution who tested positive for anti-HBc over an 18-month period. Of 44 total patients with positive anti-HBc tests, we found that 22 (50%) had previously received IVIg in the preceding 4 months. All but one of these, 21/22 (95%), went on to receive immunosuppressive therapy (IS). Among the patients who received IS, 19 (86%) had not undergone hepatitis B serologic testing prior to IVIg administration and 16 (73%) did not have subsequent testing to distinguish between passive acquisition of anti-HBc from IVIg and chronic hepatitis B infection. Our single-center experience reveals that a high proportion of positive anti-HBc tests in children are presumed to be due to passive antibody transfer from IVIg. However, a low proportion of patients undergo confirmatory testing, despite the risk of hepatitis B reactivation during IS. We thus propose a risk-based algorithm for interpretation and monitoring of hepatitis B testing in immunocompromised children. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

Hepatitis B; IVIg; immunocompromised; virus reactivation

PMID:
    30868720
DOI:
    10.1111/tid.13074

StephenW

Transpl Infect Dis。 2019年3月13日：e13074。 doi：10.1111 / tid.13074。 [印刷前的电子版]
免疫功能低下儿科患者阳性抗乙型肝炎核心抗体检测的解释和管理。
Kitt E1,2，Hayes M3，Cardenas AM2,4，Green AM1,2,5。
作者信息

1
    宾夕法尼亚州费城，费城儿童医院儿科，传染病科
2
    宾夕法尼亚大学佩雷​​尔曼医学院，宾夕法尼亚州费城。
3
    宾夕法尼亚州费城儿童医院抗菌药物管理计划。
4
    宾夕法尼亚州费城儿童医院病理学和检验医学系。
五
    宾夕法尼亚州费城，费城儿童医院儿科，肿瘤科

抽象

静脉注射免疫球蛋白（IVIg）治疗越来越多地用于儿科人群，特别是在免疫力低下的儿童中。汇集的免疫球蛋白产品通常用于检测乙型肝炎表面抗原（HBsAg）和核酸，但是通常不进行乙型肝炎核心抗体（抗HBc）的筛查。因此，给患有免疫妥协条件的儿童施用含有抗-HBc的IVIg可能使乙型肝炎血清学检测的解释复杂化，因为阳性抗-HBc试验可能代表IVIg被动转移抗体或可能表明已解决或慢性乙型肝炎感染。由于免疫功能低下患者存在乙型肝炎再激活的风险，必须仔细考虑阳性抗-HBc检测。作为质量改进计划的一部分，我们确定并审查了我们机构中所有儿童患者的记录，这些患者在18个月内检测出抗-HBc阳性。在44例抗-HBc阳性检测患者中，我们发现22例（50％）之前接受过4个月的IVIg治疗。除了这些之外的所有人，21/22（95％），继续接受免疫抑制治疗（IS）。在接受IS治疗的患者中，19例（86％）在IVIg给药前未接受乙型肝炎血清学检测，16例（73％）未进行后续检测以区分IVIg被动获得抗HBc和慢性乙型肝炎感染。我们的单中心经验表明，儿童中高比例的阳性抗-HBc测试被认为是由IVIg的被动抗体转移引起的。然而，尽管在IS期间存在乙型肝炎再激活的风险，但是低比例的患者进行确认试验。因此，我们提出了一种基于风险的算法，用于解释和监测免疫功能低下儿童的乙型肝炎检测。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

乙型肝炎;静脉注射免疫球蛋白;免疫功能低下;病毒重新激活

结论：
    30868720
DOI：
    10.1111 / tid.13074