Interpretation and management of positive anti-hepatitis B core antibody tests in immunocompromised pediatric patients.
Adolescent
Algorithms
Child
Cohort Studies
DNA, Viral
Female
Hepatitis B
/ blood
Hepatitis B Antibodies
/ blood
Hepatitis B Core Antigens
/ immunology
Hepatitis B, Chronic
/ blood
Humans
Immunization, Passive
Immunocompromised Host
Immunoglobulins, Intravenous
/ administration & dosage
Male
Mass Screening
Risk Factors
Virus Activation
hepatitis B
immunocompromised
intravenous immunoglobulin
virus reactivation
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
26
09
2018
revised:
12
02
2019
accepted:
20
02
2019
pubmed:
15
3
2019
medline:
3
8
2019
entrez:
15
3
2019
Statut:
ppublish
Résumé
Intravenous immunoglobulin (IVIg) therapy is increasingly used in the pediatric population, in particular among children with immune-compromising conditions. Pooled immunoglobulin products are routinely tested for hepatitis B surface antigen (HBsAg) and nucleic acid; however, screening for hepatitis B core antibody (anti-HBc) is not commonly performed. Thus, the administration of IVIg containing anti-HBc to children with immune-compromising conditions may complicate the interpretation of hepatitis B serologic testing in that a positive anti-HBc test may represent passive transfer of antibody from IVIg or may indicate resolved or chronic hepatitis B infection. Due to the risk of hepatitis B reactivation in immunocompromised patients, a positive anti-HBc test must be carefully considered. As part of a quality improvement initiative, we identified and reviewed the records of all pediatric patients at our institution who tested positive for anti-HBc over an 18-month period. Of 44 total patients with positive anti-HBc tests, we found that 22 (50%) had previously received IVIg in the preceding 4 months. All but one of these, 21/22 (95%), went on to receive immunosuppressive therapy (IS). Among the patients who received IS, 19 (86%) had not undergone hepatitis B serologic testing prior to IVIg administration and 16 (73%) did not have subsequent testing to distinguish between passive acquisition of anti-HBc from IVIg and chronic hepatitis B infection. Our single-center experience reveals that a high proportion of positive anti-HBc tests in children are presumed to be because of the passive antibody transfer from IVIg. However, a low proportion of patients undergo confirmatory testing, despite the risk of hepatitis B reactivation during IS. We thus propose a risk-based algorithm for interpretation and monitoring of hepatitis B testing in immunocompromised children.
Identifiants
pubmed: 30868720
doi: 10.1111/tid.13074
pmc: PMC6551281
mid: NIHMS1018423
doi:
Substances chimiques
DNA, Viral
0
Hepatitis B Antibodies
0
Hepatitis B Core Antigens
0
Immunoglobulins, Intravenous
0
Types de publication
Journal Article
Langues
eng
Pagination
e13074Subventions
Organisme : NCI NIH HHS
ID : K08 CA212299
Pays : United States
Organisme : NIH Clinical Center
ID : K08 CA212299
Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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