Hepatitis B virus reactivation sustained by a hepatitis B virus surface antigen immune-escape mutant isolate in a patient who was hepatitis B core antibody positive during treatment with sofosbuvir and velpatasvir for hepatitis C virus infection: a case report.
Antiviral Agents
/ adverse effects
Carbamates
/ adverse effects
Coinfection
/ virology
Drug Therapy, Combination
Genotype
Hepatitis B
/ virology
Hepatitis B Antibodies
/ blood
Hepatitis B Surface Antigens
Hepatitis B virus
/ genetics
Hepatitis C, Chronic
/ drug therapy
Heterocyclic Compounds, 4 or More Rings
/ adverse effects
Humans
Male
Middle Aged
Mutation
Sofosbuvir
/ adverse effects
Virus Activation
/ drug effects
Coinfection HBV/HCV
Direct acting antivirals
HBV reactivation
Hepatitis B virus
Immune-escape HBV mutant
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
22 Sep 2019
22 Sep 2019
Historique:
received:
17
12
2018
accepted:
14
08
2019
entrez:
23
9
2019
pubmed:
23
9
2019
medline:
6
2
2020
Statut:
epublish
Résumé
Although several cases of hepatitis B virus reactivation have been described in patients with a history of hepatitis B virus infection while undergoing treatment for hepatitis C virus infection with direct acting antivirals, the question of whether hepatitis B virus surface antigen immune-escape mutations might play a role has not been addressed so far. We report a case of hepatitis B virus reactivation in a Caucasian patient infected with hepatitis C virus during treatment with sofosbuvir and velpatasvir. A 50-year-old man with a genotype 1a hepatitis C virus infection was considered for therapy. His serological profile was hepatitis B virus surface antigen-negative, hepatitis B virus core antibody-positive, hepatitis B virus surface antibody-negative, and anti-hepatitis D virus-positive. The detection of hepatitis B virus deoxyribonucleic acid (DNA) indicated active viral replication during the direct acting antiviral treatment that spontaneously returned to undetectable levels after treatment completion. Starting from week 12 after the end of treatment, hepatitis B virus surface antibody titers and hepatitis B virus e antibody developed. Sequencing analysis revealed the hepatitis B virus genotype D3 and the presence of two relevant immune-escape mutations (P120S and T126I) in the major hydrophilic region by analyzing the S region. We speculate that the presence of the hepatitis B virus surface antigen mutations, endowed with the enhanced capability to elude the immune response, could play a role in hepatitis B virus reactivation. This observation confirms that occult hepatitis B infection should also be carefully monitored, through surveillance of the hepatitis B virus viral load before and during direct acting antiviral treatment of hepatitis C virus.
Sections du résumé
BACKGROUND
BACKGROUND
Although several cases of hepatitis B virus reactivation have been described in patients with a history of hepatitis B virus infection while undergoing treatment for hepatitis C virus infection with direct acting antivirals, the question of whether hepatitis B virus surface antigen immune-escape mutations might play a role has not been addressed so far.
CASE PRESENTATION
METHODS
We report a case of hepatitis B virus reactivation in a Caucasian patient infected with hepatitis C virus during treatment with sofosbuvir and velpatasvir. A 50-year-old man with a genotype 1a hepatitis C virus infection was considered for therapy. His serological profile was hepatitis B virus surface antigen-negative, hepatitis B virus core antibody-positive, hepatitis B virus surface antibody-negative, and anti-hepatitis D virus-positive. The detection of hepatitis B virus deoxyribonucleic acid (DNA) indicated active viral replication during the direct acting antiviral treatment that spontaneously returned to undetectable levels after treatment completion. Starting from week 12 after the end of treatment, hepatitis B virus surface antibody titers and hepatitis B virus e antibody developed. Sequencing analysis revealed the hepatitis B virus genotype D3 and the presence of two relevant immune-escape mutations (P120S and T126I) in the major hydrophilic region by analyzing the S region.
CONCLUSIONS
CONCLUSIONS
We speculate that the presence of the hepatitis B virus surface antigen mutations, endowed with the enhanced capability to elude the immune response, could play a role in hepatitis B virus reactivation. This observation confirms that occult hepatitis B infection should also be carefully monitored, through surveillance of the hepatitis B virus viral load before and during direct acting antiviral treatment of hepatitis C virus.
Identifiants
pubmed: 31542053
doi: 10.1186/s13256-019-2232-3
pii: 10.1186/s13256-019-2232-3
pmc: PMC6754855
doi:
Substances chimiques
Antiviral Agents
0
Carbamates
0
Hepatitis B Antibodies
0
Hepatitis B Surface Antigens
0
Heterocyclic Compounds, 4 or More Rings
0
velpatasvir
KCU0C7RS7Z
Sofosbuvir
WJ6CA3ZU8B
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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