Cerrahpasa Medical School, Istanbul University, 34098 Istanbul, Turkey.
Hepatol Int. 2010 Apr 9;4(2):530-2. doi: 10.1007/s12072-010-9177-3.
Loss of HBsAg and development of surface and core antibodies represent clinical cure. However, recent evidence suggests that hepatitis B virus (HBV) persists in a latent state even in those with mounted protective antibodies. After significant immunosuppression, anti-HBs may decrease and HBsAg may reappear (reverse seroconversion). Reverse seroconversion of HBV has been observed in association with hematopoietic stem cell transplantation, renal transplantation, intensive chemotherapy, human immunodeficiency infection, or rituximab usage.
We present here a case study of a patient with a previous high titer of anti-HBs who later developed HBV reactivation following intensive chemotherapy for leukemia.
We conclude that in immunosuppressed patients with a history of HBV infection may carry a risk for reverse seroconversion and monitoring anti-HBs levels may help recognising this risk.
HBsAg 的丢失和表面及核心抗体的产生代表临床治愈。然而,最近的证据表明,乙型肝炎病毒(HBV)即使在产生保护性抗体的情况下也会以潜伏状态存在。在显著免疫抑制后,抗-HBs 可能会减少,HBsAg 可能会再次出现(逆转血清转换)。HBV 的逆转血清转换已在造血干细胞移植、肾移植、强化化疗、人类免疫缺陷感染或利妥昔单抗使用中观察到。
我们在此介绍一例患者,该患者既往抗-HBs 滴度较高,后因白血病强化化疗而发生 HBV 再激活。
我们得出结论,在有 HBV 感染史的免疫抑制患者中,可能存在逆转血清转换的风险,监测抗-HBs 水平可能有助于识别这种风险。