核苷类似物治疗停药后非肝硬化 HBV 患者肝移植后病毒再激活。
Virus reactivation in a non-cirrhotic HBV patient requiring liver transplantation after cessation of nucleoside analogue therapy.
机构信息
Division of Gastroenterology/Hepatology, 2697Scripps Clinic, La Jolla, CA, USA.
Department of Immunology and Microbiology, 478079The Scripps Research Institute, La Jolla, CA, USA.
出版信息
Antivir Ther. 2021 Jan-Feb;26(1-2):3-8. doi: 10.1177/13596535211042205. Epub 2021 Sep 26.
Abstract
Nucleos(t)ide analogues (NAs) are a mainstay of therapy for chronic hepatitis B (CHB) infections and have a profound effect on hepatitis B virus (HBV) suppression. We report a rare case of HBV reactivation in a CHB patient without cirrhosis following cessation of NA therapy that resulted in acute liver failure requiring liver transplantation. Investigation of the viral genetics and host immune responses suggest that viral mutations known to promote virus replication are associated with reactivation, whereas adaptive immunity to HBV remained defective in this patient. Viral sequencing may be useful for identifying mutations that are unfavorable for therapy withdrawal.
摘要
核苷酸类似物 (NAs) 是慢性乙型肝炎 (CHB) 感染治疗的主要方法，对乙型肝炎病毒 (HBV) 抑制有深远影响。我们报告了一例罕见的 CHB 患者在停止 NA 治疗后发生 HBV 再激活导致急性肝功能衰竭需要肝移植的病例。对病毒遗传学和宿主免疫反应的研究表明，已知促进病毒复制的病毒突变与再激活有关，而该患者对 HBV 的适应性免疫仍然存在缺陷。病毒测序可能有助于识别不利于停药的突变。
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