Hepatitis B Reactivation after Stem Cell Transplantation

In the February 2007 Journal of Clinical Virology, German researchers described a case of reactivation of hepatitis B virus (HBV) infection after allogeneic (from a different person) stem cell transplantation. HBV infections typically result in life-long persistence of HBV core antibodies (anti-HBc).

Case Report

•A 44-year-old female presented 10 years after allogeneic stem cell transplantation with chronic hepatitis B.

• The infection had reactivated from a previously resolved HBV infection acquired some years prior to transplantation.

• The woman previously tested positive for HBV core and surface antibodies (anti-HBs and anti-HBc).

• After stem cell transplantation, she lost all antibodies to HBV, including anti-HBc.

• The sequence of HBV surface and core genes did not reveal any escape mutations.

• Thus, the researchers concluded, the loss of anti-HBc might suggest immunotolerance of the stem cell donor's immune system against hepatitis B core antigens.

Conclusion

"This data illustrate[s] that an HBV infection might be reactivated despite high anti-HBs levels prior to transplantation," the authors concluded. "Furthermore, this is the first patient in which a complete loss of anti-HBc could be documented."

Moreover, they added, "since anti-HBc is often used as a screening marker for HBV, it should be kept in mind that anti-HBc negative patients with high viremic HBV infection may occur."

02/06/07

Reference
B C Gartner, W Jung, C Welsch, and others. Permanent loss of anti-HBc after reactivation of hepatitis B virus infection in an anti-HBs and anti-HBc-positive patient after allogeneic stem cell transplantation. Journal of Clinical Virology 38(2): 146-148. February 2007.