Spontaneous reactivation of hepatitis B virus (HBV) infection in patients with resolved or occult HBV infection.

Abstract

Reactivation of a former hepatitis B virus (HBV) infection can be triggered by immunosuppressive therapy, diseases associated with an immunocompromised state, organ transplantation or the withdrawal of antiviral drugs. Despite the absence of such risk factors, a spontaneous reactivation of HBV replication occurred in two elderly patients with resolved or occult HBV infection. A 73-year-old male underwent coronary artery bypass grafting in October 2008, and was negative for HBsAg but positive for anti-HBs. In July 2009, his serum became positive for HBsAg, HBeAg and HBV DNA (6.4 log copies/ml; genotype C), but negative for anti-HBc IgM, with abrupt elevation of the liver enzymes. The entire genomic sequence of HBV recovered from this patient revealed no mutations in the core promoter and precore regions that interfere with HBeAg production. A 76-year-old male with a history of endoscopic mucosal resection for esophageal cancer in 2002 and an initial diagnosis of diabetes mellitus in 2009, at which time he was negative for HBsAg. He was found to be positive for HBsAg in September 2012 during a laboratory examination performed prior to the resection of recurrent esophageal cancer, despite a low HBV load (2.1 log copies/ml). Three months later, without the administration of any anticancer drugs, the HBV DNA (genotype B) level increased to 5.1 log copies/ml. A precore G1896A variant with high quasispecies diversity was recovered from the patient. Aging, surgical stress and complication of disease(s) associated with compromised immunity, such as cancer, arteriosclerosis and diabetes mellitus may trigger spontaneous HBV reactivation.

• Authors: Hiroshi Kamitsukasa, Masanobu Iri, Akihisa Tanaka, Shigeo Nagashima, Masaharu Takahashi, Tsutomu Nishizawa, Hiroaki Okamoto
• Journal: Journal of medical virology (J Med Virol) Vol. 87 Issue 4 Pg. 589-600 (Apr 2015) ISSN: 1096-9071 [Electronic] United States
• PMID: 25612181 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• DNA, Viral
• Hepatitis B Antibodies
• Hepatitis B Surface Antigens

Topics

• Aged
• Coronary Artery Bypass (adverse effects)
• DNA, Viral (blood, chemistry, genetics)
• Endoscopy (adverse effects)
• Esophageal Neoplasms (complications)
• Genotype
• Hepatitis B (epidemiology, virology)
• Hepatitis B Antibodies (blood)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B virus (physiology)
• Humans
• Immunocompromised Host
• Male
• Molecular Sequence Data
• Sequence Analysis, DNA
• Virus Activation