The reactivation of occult HBV infection emerging with the case of acute hepatitis B in the wife of a subject treated with rituximab-based chemotherapy

Aim. Assessment of the clinical impact of previous hepatitis B infection (PHB).Key points. PHB is characterized by the presence of viral DNA in the organism (including intrahepatic cccDNA and integrated DNA). Possible virus persistence in the PHB patient's hepatocytes potentiates the agent transmission risk via haemotransfusion, organ transplantation and haemodialysis. Occult HBV infection in PHB individuals can reactivate at background immunosuppressive or chemotherapies. PHB with chronic liver diseases of various aetiology significantly rises the risk of cirrhosis and hepatic cancer. The PHB association with autoimmune liver diseases and extrahepatic gastrointestinal cancer needs a careful research to confirm the possible involvement of hepatitis B virus in morbid genesis.Conclusion. No clinical signs of acute or chronic disease, HBsAg clearance and negative viral DNA load in blood of PHB individuals do not necessarily imply a complete disease eradication.PHB elicitation improves accuracy of the overall prognosis, reduces the virus transmission risk and prevents the reactivation of HBV infection.

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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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Molecular analysis of hepatitis B virus (HBV) in an HIV co-infected patient with reactivation of occult HBV infection following discontinuation of lamivudine-including antiretroviral therapy

BMC Infectious Diseases ◽

10.1186/1471-2334-11-310 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 14

Author(s):

Andrea Costantini ◽

Katia Marinelli ◽

Giulia Biagioni ◽

Alessia Monachetti ◽

Monica L Ferreri ◽

...

Keyword(s):

Hepatitis B Virus ◽

Antiretroviral Therapy ◽

Hepatitis B ◽

Molecular Analysis ◽

Infected Patient ◽

Hbv Infection ◽

Occult Hbv Infection ◽

Occult Hbv ◽

B Virus

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Hepatitis B vaccination with or without hepatitis B immunoglobulin at birth to babies born of HBsAg-positive mothers prevents overt HBV transmission but may not prevent occult HBV infection in babies: a randomized controlled trial

Journal of Viral Hepatitis ◽

10.1111/jvh.12102 ◽

2013 ◽

Vol 20 (11) ◽

pp. 801-810 ◽

Cited By ~ 9

Author(s):

C. Pande ◽

S. K. Sarin ◽

S. Patra ◽

A. Kumar ◽

S. Mishra ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hepatitis B ◽

Controlled Trial ◽

Hbv Infection ◽

Hepatitis B Vaccination ◽

Occult Hbv Infection ◽

Randomized Controlled ◽

Occult Hbv ◽

Hepatitis B Immunoglobulin ◽

Hbv Transmission

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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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A new method of concentrating hepatitis B virus (HBV) DNA and HBV surface antigen: an application of the method to the detection of occult HBV infection

Vox Sanguinis ◽

10.1111/j.1423-0410.2008.01091.x ◽

2008 ◽

Vol 95 (3) ◽

pp. 174-180 ◽

Cited By ~ 15

Author(s):

K. Satoh ◽

A. Iwata-Takakura ◽

A. Yoshikawa ◽

Y. Gotanda ◽

T. Tanaka ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Surface Antigen ◽

Hbv Dna ◽

Hbv Infection ◽

New Method ◽

Occult Hbv Infection ◽

Occult Hbv ◽

B Virus

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Development of occult hepatitis B viral infection in pregnancy: implications for antenatal screening in women from endemic areas

Obstetric Medicine ◽

10.1258/om.2010.090057 ◽

2010 ◽

Vol 3 (3) ◽

pp. 115-118

Author(s):

Philip Chang ◽

Jeffrey Tu ◽

Antony Chesterman ◽

Robert Kim ◽

Peter Robertson ◽

...

Keyword(s):

Hepatitis B ◽

Vertical Transmission ◽

Peripheral Blood ◽

Hbv Dna ◽

Hbv Infection ◽

Antenatal Screening ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

Occult Hepatitis B

Occult hepatitis B virus (HBV) infection, manifest clinically by the presence of HBV deoxyribonucleic acid (HBV DNA) in peripheral blood in individuals who test negative for the HBV surface antigen (HBsAg), may occur in various clinical contexts, including under the influence of pharmacological immunosuppression in patients from areas endemic for HBV and, hence, at risk of previous exposure. Pregnancy is a condition associated with immune suppression, but whether virus-specific immunity may be suppressed to an extent sufficient to allow occult HBV infection to develop is currently unknown. This is potentially relevant not only to the mother's health but also because vertical transmission has been reported in the occult HBV infection setting. We report a 30-year-old woman from a country endemic for HBV who, prior to pregnancy, was persistently HBsAg-negative with undetectable HBV DNA in peripheral blood, in whom HBV DNA became increasingly detectable during pregnancy, peaking in the third trimester, before returning to undetectable levels postpartum. HBsAg remained negative and liver function tests were normal throughout. Immunoglobulin M hepatitis B core antibody, a marker of the possibility of acquisition of a new HBV infection, was also negative. The baby received immunization against HBV infection from birth and has remained HBV negative at six months. This report documents for the first time that occult HBV infection may develop during pregnancy. Further data are required regarding the prevalence of this phenomenon, predisposing factors, impact on maternal health and risk of vertical transmission so that implications for current antenatal screening strategies that do not include measurement of HBV DNA in peripheral blood can be properly determined.

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