Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient
Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient
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DOI：
10.1016/j.jcv.2006.10.006
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发表时间：
2007-01-01
影响因子：
8.8
通讯作者：
Gerlich, Wolfram H.
中科院分区：
文献类型：
--
作者：
Awerkiew, Sabine;Daeumer, Martin;Gerlich, Wolfram H.
背景：乙肝病毒在消退后通常会持续存在，但其复制可被抗病毒T细胞抑制。免疫抑制治疗可能导致病毒重新激活和严重肝炎。早期抗病毒治疗可防止再次激活，但一些隐匿性的乙肝病毒感染不易被发现。结果：我们描述了一例进行性非霍奇金淋巴瘤患者，他可能没有接种过乙肝疫苗，在免疫抑制之前，抗病毒表面抗原的抗体(抗-HBs)是唯一可能的隐匿性乙肝病毒感染的标志物。在免疫抑制下，他出现了病毒血症(>；10(8)拷贝/毫升)。该病毒存在3个S基因突变(L109R、C137W、G145R)，导致假阴性结果和疫苗诱导的抗-HBs结合减弱。结论：对严重免疫低下患者的可靠筛查和监测，除抗-HBc和HBs Ag外，还应包括抗-HBs和敏感的HBVDNA检测。此外，主动接种疫苗或乙肝免疫球蛋白可能无法预防这种突变。(C)2006爱思唯尔B.V.保留所有权利。
Background: Hepatitis B virus (HBV) often persists after resolution, but its replication is suppressed by antiviral T cells. Immunosuppressive treatment may lead to viral reactivation and severe hepatitis. Early antiviral therapy prevents reactivation but some occult HBV infections are not easily detectable.Results: Here we describe a patient with a progressive non-Hodgkin lymphoma who had probably not been vaccinated against HBV and, before immunosuppression, showed antibodies (anti-HBs) against the viral surface antigen (HBsAg) as the only possible marker of occult HBV infection. Under immunosuppression he developed viremia (> 10(8) copies/mL). The virus exhibited three S gene mutations (L109R, C137W, G145R) which led to false negative HBsAg results and diminished binding of vaccine-induced anti-HBs.Conclusions: Reliable screening and monitoring of severely immunosuppressed patients for HBV should include, in addition to anti-HBc and HBsAg, anti-HBs and sensitive HBV DNA assays. Furthermore, active vaccination or hepatitis B immune globulin may not protect against such mutants. (c) 2006 Elsevier B.V. All rights reserved.