AI Summary & Key Takeaways
AI InsightPrior to the creation of regular follow-up or prophylaxis schemes of patients with resolved HBV infection, in whom immune suppressive and anti-cancer treatments or HSCT will be performed, close follow-up of patients for HBV reverse sero-conversion even in late stages after immune suppressive and anti-cancer treatments or HSCT seems beneficial, especially in regions with intermediate or high endemicity for HBV
📌 3 Key Takeaways
Abstract
Recovery and immunity to hepatitis B virus (HBV) are marked by antibody to hepatitis B core antigen (anti-HBc) with or without antibody to hepatitis B surface antigen (anti-HBs) in the absence of hepatitis B surface antigen (HBsAg). In the profoundly immune compromised individual, HBV may reactivate even in the presence of serologic evidence of resolved infection. The loss of anti-HBs followed by reactivation with development of HBsAg is known as reverse sero-conversion. A 62-year-old female patient with the diagnosis of IgG type of multiple myeloma had received bortezomib-based chemotherapy, and autologous hematopoietic stem cell transplantation (HSCT) was performed thereafter. A 56-year-old male patient with the diagnosis of chronic lymphocytic leukemia had received 6 cures of rituximab-endoxan chemotherapy. Prior to chemotherapy, HBsAg was negative, anti-HBs positive, anti- HBc positive and HBV-DNA was negative in both patients. Approximately one year after chemotherapy, HBV reverse sero-conversion developed in both patients. Resolved HBV infection with undetectable HBV-DNA before chemotherapy or HSCT did not confer HBV reverse sero-conversion. Prior to the creation of regular follow-up or prophylaxis schemes of patients with resolved HBV infection, in whom immune suppressive and anti-cancer treatments or HSCT will be performed, close follow-up of patients for HBV reverse sero-conversion even in late stages after immune suppressive and anti-cancer treatments or HSCT seems beneficial, especially in regions with intermediate or high endemicity for HBV
Özet
Hepatit B virüsü (HBV)'ne gelişen immünite ve iyileşme hepatit B yüzey antijeni (HBsAg) yokluğunda hepatit B core antijenine karşı gelişen antikor (anti-HBc) ve/veya hepatit B yüzey antijenine karşı gelişen antikor (anti-HBs) ile belirlenir. Ciddi immün kompromize bireylerde düzelmiş infeksiyonun serolojik kanıtları bulunsa dahi HBV reaktive olabilir. HBsAg gelişimiyle birlikte anti-HBs kaybı tersine serokonversiyon olarak bilinir. Altmış iki yaşında IgG tipi multipl miyelom tanılı kadın hastaya bortezomib bazlı kemoterapi verildi ve bundan sonra otolog hematopoietik kök hücre nakli (HKHN) yapıldı. Elli altı yaşında kronik lenfositik lösemi tanılı bir erkek hastaya altı kür rituksimab-siklofosfamid kemoterapisi verildi. Kemoterapiden önce her iki hastada HBsAg negatif, anti-HBs pozitif, anti-HBc pozitif, HBV-DNA negatifti. Kemoterapiden yaklaşık bir yıl sonra her iki hastada da HBV ters serokonversiyonu gelişti. Kemoterapi veya HKHN'den önce saptanamayan HBV-DNA düzeyleri ile birlikte iyileşmiş HBV infeksiyonu HBV ters serokonversiyonu olmayacağını göstermedi. Özellikle HBV için orta veya yüksek endemik olan bölgelerde, immünsüpresif ve antikanser tedavi veya HKHN uygulanacak hastalar için düzenli izlem ve profilaksi programlarının oluşturulması, immünsüpresif, antikanser veya HKHN tedavisinden sonra geç dönemde olsa bile hastaların HBV ters serokonvesiyonu için yakın takip edilmesi yararlı olacak gibi görünmektedir