title: 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.
abstract: BACKGROUND
  Reactivation of a hepatitis B virus (HBV) infection after transplantation is associated with a high morbidity and mortality. HBV infections generally result in anti-HBc persisting lifelong.
  
  
  METHODS
  A 44-year-old female presented 10 years after allogeneic stem cell transplantation with a chronic hepatitis B. The infection was reactivated from a resolved (anti-HBs and anti-HBc positive) HBV infection acquired some years prior to transplantation. Interestingly, she lost all antibodies to HBV including anti-HBc and is upto now anti-HBc negative. The sequence of the surface and the core gene did not reveal any escape mutations. Thus, the loss of anti-HBc might suggest an immunotolerance of the donor's immune system against HBcAg.
  
  
  CONCLUSIONS
  This data illustrate that an HBV infection might be reactivated despite high anti-HBs levels prior to transplantation. Furthermore, this is the first patient in which a complete loss of anti-HBc could be documented. Moreover, 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.
authors.affiliation: Institute of Virology 1 and Clinic of Internal Medicine 3, University of Saarland, Medical School, Homburg/Saar, Germany.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Gärtner
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jung
authors.forename: Christoph
authors.initials: C
authors.lastname: Welsch
authors.forename: Johannes
authors.initials: J
authors.lastname: Fischinger
authors.forename: Jörg
authors.initials: J
authors.lastname: Schubert
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Mueller-Lantzsch
authors.forename: Ulrike C
authors.initials: UC
authors.lastname: Wend
authors.forename: Wolfram H
authors.initials: WH
authors.lastname: Gerlich
mesh_terms: D000328:Adult; D005260:Female; D006512:Hepatitis B Core Antigens / Q000097:blood / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology*; D006515:Hepatitis B virus / Q000254:growth & development / Q000276:immunology / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000276:immunology* / Q000821:virology; D006801:Humans; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D014775:Virus Activation
chemical_list: D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens