Occult Hepatitis B Virus Infection in a Previously Vaccinated Injection Drug User.
Occult Hepatitis B Virus Infection in a Previously Vaccinated Injection Drug User.
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DOI：
10.5812/hepatmon.34758
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发表时间：
2016-02
影响因子：
0.6
通讯作者：
Blackard JT
中科院分区：
文献类型：
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作者：
Powell EA;Razeghi S;Zucker S;Blackard JT
隐匿性乙型肝炎病毒 (HBV) 的定义是患者血清中存在 HBV DNA，但不存在 HBsAg。隐匿性乙型肝炎病毒与肝细胞癌、免疫抑制过程中的再激活以及传播给他人有关。虽然乙型肝炎疫苗在预防慢性乙型肝炎方面非常有效，但最近的研究表明，它在预防婴儿接种疫苗后的隐匿性乙型肝炎方面效果较差。然而，尚无研究检验成人乙型肝炎疫苗接种在预防隐匿性乙型肝炎方面的功效。在这里，我们提出第一份成人疫苗接种后隐匿性乙型肝炎的报告。一名 21 岁的白人女性因甲氧西林敏感金黄色葡萄球菌继发三尖瓣心内膜炎，并伴有非缺血性心肌病。她报告称积极使用静脉注射药物。她的肝酶升高（ALT = 1873 IU/mL；AST = 4518 IU/mL），并且发现她患有 HCV 和隐匿性 HBV。住院期间 HBV 病毒载量范围为 4608 - 8364 拷贝 IU/mL。对患者的 HBV 进行测序，发现基因型为 D3，没有任何已知的诊断逃逸突变。没有观察到可能阻止 HBsAg 检测的免疫复合物。婴儿期接种乙肝疫苗可有效预防慢性乙肝病毒感染，但预防隐匿性乙肝病毒感染的效果较差。尚未进行类似的研究来检验成人乙型肝炎疫苗接种在预防隐匿性乙型肝炎方面的功效。该病例凸显了仔细确定高危人群 HBV 状况的重要性，因为即使没有 HBsAg，疫苗接种史和抗 HBs 的存在也可能不足以排除 HBV 感染。
Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.