Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient

J Clin Virol. 2007 Jan;38(1):83-6. doi: 10.1016/j.jcv.2006.10.006. Epub 2006 Nov 28.

Abstract

Background: Hepatitis B virus (HBV) often persists after resolution, but its replication is suppressed by antiviral T cells. Immunosuppressive treatment may lead to viral reactivation and severe hepatitis. Early antiviral therapy prevents reactivation but some occult HBV infections are not easily detectable.

Results: Here we describe a patient with a progressive non-Hodgkin lymphoma who had probably not been vaccinated against HBV and, before immunosuppression, showed antibodies (anti-HBs) against the viral surface antigen (HBsAg) as the only possible marker of occult HBV infection. Under immunosuppression he developed viremia (>10(8)copies/mL). The virus exhibited three S gene mutations (L109R, C137W, G145R) which led to false negative HBsAg results and diminished binding of vaccine-induced anti-HBs.

Conclusions: Reliable screening and monitoring of severely immunosuppressed patients for HBV should include, in addition to anti-HBc and HBsAg, anti-HBs and sensitive HBV DNA assays. Furthermore, active vaccination or hepatitis B immune globulin may not protect against such mutants.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • False Negative Reactions
  • Hepatitis B / blood
  • Hepatitis B / etiology*
  • Hepatitis B / virology
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B Surface Antigens / genetics
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B virus / physiology*
  • Humans
  • Immunocompromised Host
  • Lymphoma, Non-Hodgkin / complications*
  • Lymphoma, Non-Hodgkin / immunology
  • Male
  • Mutation
  • Viremia
  • Virus Activation

Substances

  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens