The Combination of Nucleotide Analog Therapy and Steroid Pulse Therapy for Acute HBV Infection Effectively Promotes HBV Clearance

Acute hepatitis B virus (HBV) infection occasionally progresses to acute liver failure, often with poor prognosis. The appropriate pharmacological approach is yet to be established. Although nucleotide analogs (NA) and corticosteroids are candidates for the treatment of acute HBV infection, their therapeutic effects, especially their effect on HBV clearance, remain unclear. To clarify effects on the HBV clearance of combination therapy of NA and steroid pulse therapy (SPT) for acute HBV infection, we first analyze the effectiveness of this therapy in patients with HBV infection compared with NA monotherapy (NAM). Of the 57 consecutive patients with acute hepatitis B infection from May 2007 to December 2018, we have included 25 patients for this study, whom we followed up until HBV clearance. According to the administration of NA and SPT, we divided patients into two groups (NAM group and NA + SPT group) and compared their results. Of the 25 patients, 10 received NAM, whereas 15 received NA + SPT. There were no appreciable adverse effects related to SPT. The time required for the clearance of HBsAg (76 (43–116) days vs. 26 (14–51) days, p = 0.0418) and HBV-DNA (NAM group vs. NA + SPT group: 180 (83.5–220) vs. 69 (43–136) days, p = 0.0420) was significantly shorter in the NA + SPT group than in the NAM group. The hazard ratio of NA + SPT for the clearance of HBsAg and HBV-DNA were 0.45 (0.19–1.09) and 0.35 (0.14–0.89), respectively. In conclusion, we showed that NA + SPT promoted HBV elimination. These findings support the use of the NA + SPT combination for acute HBV infection without the concern of persistent HBV infection.

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Protracted HBsAg-aemia in a Patient with Acute Hepatitis B

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2018-28-5-126-133 ◽

2018 ◽

Vol 28 (5) ◽

pp. 126-133

Author(s):

K. R. Dudina ◽

O. O. Znoyko

Keyword(s):

Hepatitis B ◽

Acute Hepatitis ◽

Dynamic Assessment ◽

Hbv Dna ◽

Hbv Infection ◽

Observation Study ◽

Viral Kinetics ◽

Chronic Hbv Infection ◽

Acute Hepatitis B ◽

Chronic Hbv

Aim.This clinical observation was aimed at analysing the course of the disease in a patient with a protracted persistence of HBsAg and HBV DNA in the blood in the outcome of acute hepatitis B and the possible formation of a latent HBV infection in the phase of clinical recovery.General findings. We carried out a 31-month observation study of a patient suffering from acute hepatitis B. Subsequently, we performed a dynamic assessment of the viral kinetics and qualitative and quantitative assessment of HBsAg in the blood using highly sensitive analytical methods. These methods allowed a protracted persistence of HBV DNA in the blood and a late seroconversion of HBsAg/anti-HBs to be revealed.Conclusion.The described clinical case demonstrates the possibility of an atypically protracted persistence of HBsAg in the outcome of acute hepatitis B, which is followed by a clinical and laboratory picture of recovery and the formation of latent chronic HBV infection, as an example of the 5th phase of chronic HBV infection (HBsAg-negative), according to a new classification, reflected in the clinical guidelines for the treatment of hepatitis B (EASL 2017).

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Acute Hepatitis B Co-infection in HIV-Infected Patients Despite Prior Hepatitis B Vaccination

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v11i4.188 ◽

2017 ◽

Vol 11 (4) ◽

Author(s):

S. Rolland ◽

L. Antonova ◽

J. Powis ◽

T. Murdoch ◽

D. Wong ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Acute Hepatitis ◽

Elevated Risk ◽

Vaccination Status ◽

Hbv Infection ◽

Hepatitis B Vaccination ◽

Hiv Patients ◽

B Virus ◽

Acute Hepatitis B

Clinicians often assume that patients vaccinated for hepatitis B virus (HBV) have immunity. We report three cases of acute HBV infection in HBV-vaccinated HIV patients. These cases illustrate that patients at an elevated risk of HBV exposure presenting with acute hepatitis should be tested for HBV infection regardless of previous vaccination status.

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Cytotoxic T lymphocytes recognize an HLA-A2-restricted epitope within the hepatitis B virus nucleocapsid antigen.

Journal of Experimental Medicine ◽

10.1084/jem.174.6.1565 ◽

1991 ◽

Vol 174 (6) ◽

pp. 1565-1570 ◽

Cited By ~ 252

Author(s):

A Penna ◽

F V Chisari ◽

A Bertoletti ◽

G Missale ◽

P Fowler ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Acute Hepatitis ◽

Mononuclear Cells ◽

Cell Injury ◽

Hbv Infection ◽

Chronic Patients ◽

Ctl Response ◽

B Virus ◽

Acute Hepatitis B

The absence of readily manipulable experimental systems to study the cytotoxic T lymphocyte (CTL) response against hepatitis B virus (HBV) antigens has thus far precluded a definitive demonstration of the role played by this response in the pathogenesis of liver cell injury and viral clearance during HBV infection. To circumvent the problem that HBV infection of human cells in vitro for production of stimulator/target systems for CTL analysis is not feasible, a panel of 22 overlapping synthetic peptides covering the entire amino acid sequence of the HBV core (HBcAg) and e (HBeAg) antigens were used to induce and to analyze the HBV nucleocapsid-specific CTL response in nine patients with acute hepatitis B, six patients with chronic active hepatitis B, and eight normal controls. By using this approach, we have identified an HLA-A2-restricted CTL epitope, located within the NH2-terminal region of the HBV core molecule, which is shared with the e antigen and is readily recognized by peripheral blood mononuclear cells from patients with self-limited acute hepatitis B but less efficiently in chronic HBV infection. Our study provides the first direct evidence of HLA class I-restricted T cell cytotoxicity against HBV in humans. Furthermore, the different response in HBV-infected subjects who successfully clear the virus (acute patients) in comparison with patients who do not succeed (chronic patients) suggests a pathogenetic role for this CTL activity in the clearance of HBV infection.

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