Severe hepatitis B reactivation during direct-acting antiviral treatment in "the absence" of hepatitis B surface antigen

Int J Infect Dis. 2019 Feb:79:47-49. doi: 10.1016/j.ijid.2018.11.014. Epub 2018 Nov 26.

Abstract

Hepatitis C virus (HCV) treatment with direct-acting antivirals (DAA) can be associated with reactivation of hepatitis B (HBV). We report a case of a kidney transplant recipient who had a fatal severe HBV reactivation during treatment for chronic hepatitis C with DAA. Diagnosis of HBV reactivation was delayed due to undetectable surface antigen (HBsAg) by standard assays. The latter was explained by the presence of HBsAg escape mutants. The case illustrates the relevance of HBV-DNA testing in transplant recipients with previous exposure to HBV, even in the absence of HBsAg, and particularly when liver test abnormalities are present.

Keywords: DAA; Escape mutants; Reactivation.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / therapeutic use
  • Coinfection*
  • Fatal Outcome
  • Hepatitis B / complications
  • Hepatitis B / virology*
  • Hepatitis B Surface Antigens / analysis
  • Hepatitis B virus / physiology*
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Transplant Recipients
  • Virus Activation*

Substances

  • Antiviral Agents
  • Hepatitis B Surface Antigens