Reactivation of resolved hepatitis B virus infection with immune escape mutations after long-term corticosteroid therapy
Reactivation of resolved hepatitis B virus infection with immune escape mutations after long-term corticosteroid therapy
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DOI：
10.1007/s12328-016-0631-1
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发表时间：
2016-04-01
影响因子：
1
通讯作者：
Shimosegawa, Tooru
中科院分区：
文献类型：
--
作者：
Inoue, Jun;Kondo, Yasuteru;Shimosegawa, Tooru
乙肝病毒(乙肝病毒)从已解决的感染中重新激活是一个严重的问题，经常会导致重型肝炎。通常，它发生在免疫抑制治疗开始后的几个月；然而，它有时发生在几年后，甚至在停止治疗之后。我们在此报告一位新近感染乙肝病毒的病人，他已接受糖皮质激素治疗寻常型天疱疮6年。用系列血清样本进行的全基因组序列分析显示，患者感染了乙肝病毒亚型C2，其前C区有G1896R混合突变。有趣的是，它在S基因中存在免疫逃逸突变P120A和G145R。由于在新感染时，乙肝表面抗原和抗乙肝表面抗原抗体均为阳性，因此认为具有这些变异的乙肝病毒逃脱了已有的乙肝表面抗体的中和。此病例表明，免疫逃逸突变的乙肝病毒在免疫抑制治疗后很长一段时间内可重新激活。
Hepatitis B virus (HBV) reactivation from resolved infection is a serious problem which can frequently lead to severe hepatitis. Generally, it occurs several months after the start of immunosuppressive therapy; however, it sometimes occurs a few years later, even after cessation of therapy. Here we report a patient with de novo HBV infection who had received corticosteroid therapy for pemphigus vulgaris for 6 years. Full-genome HBV sequence analysis using serial serum samples revealed that the patient was infected with HBV subgenotype C2, which had the G1896R mixed mutation in the precore region. Interestingly, it had the immune escape mutations P120A and G145R in the S gene. Because both hepatitis B surface antigen and antibodies to hepatitis B surface antigen (HBsAb) were positive at the onset of the de novo infection, it was considered that HBV with these mutations escaped from neutralization by the pre-existing HBsAbs. This case indicates that HBV reactivation with an immune escape mutant can occur long after immunosuppressive therapy.