De Novo Superinfection of Hepatitis B Virus in an Anti-HBs Positive Patient with Recurrent Hepatitis C Following Liver Transplantation.
- Author:
Sung Hae HA
1
;
Young Min PARK
;
Sun Pyo HONG
;
So Ya BACK
;
Soo Kyeong SHIN
;
Seung Il JI
;
Soo Ok KIM
;
Wang don YOO
;
Bo Hyun KIM
;
Sang Jong PARK
;
Zheng HONG
Author Information
1. Hepatology Center, Bundang Jesaeng General Hospital, Seongnam, Korea. ymp1@hotmail.com
- Publication Type:Case Report
- Keywords:
De novo hepatitis B virus infection;
Occult hepatitis B virus infection;
Post-orthotopic liver transplantation recurrent hepatitis C;
Orthotopic liver transplantation
- MeSH:
Antibodies;
Biopsy;
Codon;
DNA;
Female;
Genotype;
Hepacivirus;
Hepatitis;
Hepatitis B;
Hepatitis B e Antigens;
Hepatitis B Surface Antigens;
Hepatitis B virus;
Hepatitis C;
Hepatocytes;
Humans;
Immunoglobulin M;
Interferon-alpha;
Liver;
Liver Cirrhosis;
Liver Transplantation;
Middle Aged;
Ribavirin;
Superinfection;
Viruses
- From:Gut and Liver
2011;5(2):248-252
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1x10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.
