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Mixed cryoglobulinemia type II in chronic hepatitis B associated with HBe-minus HBV mutant: cellular immune reactions and response to interferon treatment.

Abstract
The case of a young female patient with chronic active hepatitis B, vasculitic purpura, edema, and circulating immune complexes due to mixed cryoglobulinemia is described. Serum transaminases were elevated. Serological assays showed hepatitis B surface antigen (HBsAg), antibody to hepatitis B e antigen (anti-HBe), and antibody to hepatitis B core antigen (anti-HBc) antibodies but no antibody to hepatitis C virus (anti-HCV) or antibody to hepatitis delta virus (anti-HDV) antibodies. Using hepatitis B virus-polymerase chain reaction (HBV-PCR) and direct sequencing a precore/core (preC/C) mutant unable to synthesize HBeAg was detected in serum. HBV antigens were demonstrated in the circulating immune complexes. Following 1 month of treatment with interferon-alpha 2b3 miu three times weekly, alanine aminotransferases returned to normal levels while cryoglobulins and immune complexes disappeared from serum. In addition, 2 months after the onset of treatment serum HBV-DNA was no longer detectable by PCR. Prior to treatment the analysis of cellular immune reactions of peripheral blood mononuclear cells showed a major proliferative response to HBcAg, preS1Ag and HBxAg and a minor response to HBeAg and HBsAg. One month after conclusion of treatment a decline in T-cell reactivity against all HBV antigens was observed. During clinical response to the therapy, however, a strong proliferative response of T cells to HBcAg and HBeAg was demonstrated. In conclusion, immune complex disease may complicate chronic hepatitis B in patients expressing HBe-minus HBV mutants. Treatment with interferon-alpha was found to be effective in mixed cryoglobulinemia even in the presence of HBe-minus HBV mutants.(ABSTRACT TRUNCATED AT 250 WORDS)
AuthorsH Löhr, B Goergen, W Weber, W Gödderz, K H Meyer zum Büschenfelde, G Gerken
JournalJournal of medical virology (J Med Virol) Vol. 44 Issue 4 Pg. 330-5 (Dec 1994) ISSN: 0146-6615 [Print] United States
PMID7897364 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Hepatitis B e Antigens
  • Interferon-alpha
Topics
  • Adolescent
  • Cryoglobulinemia (complications, immunology, therapy)
  • Female
  • Follow-Up Studies
  • Hepatitis B (complications, immunology, therapy, virology)
  • Hepatitis B e Antigens (blood, genetics)
  • Hepatitis B virus (genetics, immunology)
  • Hepatitis, Chronic (complications, immunology, therapy)
  • Humans
  • Immunity, Cellular
  • Interferon-alpha (therapeutic use)
  • Leukocytes, Mononuclear (immunology)
  • Mutation
  • T-Lymphocytes (immunology)

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