title: Early upsurge in anti-HBs titer possibly caused by the immunomodulative, not by the mutagenetic effect of interferon and ribavirin.
abstract: A patient with chronic hepatitis B and C undergoing treatment with interferon and ribavirin showed an upsurge in hepatitis B virus surface antibody (anti-HBs) titer, accompanied by a decrease in hepatitis B virus surface antigen (HBsAg) during the early treatment phase. Simultaneously, elevation of alanine aminotransferase (ALT) was observed. Subsequently, the hepatitis B virus (HBV) DNA titer decreased and HBV e antigen (HBeAg) to anti-HBe seroconversion occurred. The anti-HBs titer gradually returned to the pretreatment level after cessation of ribavirin treatment and HBV-DNA became undetectable. We found no nucleotide mutations in HBV-DNA that could explain the sudden elevation in anti-HBs titer. The appearance of anti-HBs was considered to be a break in immune tolerance against some epitopes in HBsAg, possibly the r epitope, stimulated by interferon/ribavirin treatment. The immunomodulatory effect of ribavirin might have caused this unexpected early immune response to HBsAg that preceded seroconversion to anti-HBe.
authors.affiliation: Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences of Niigata University, Niigata-city, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Shogo
authors.initials: S
authors.lastname: Ohkoshi
authors.forename: Masaki
authors.initials: M
authors.lastname: Maruyama
authors.forename: Yo-Hei
authors.initials: YH
authors.lastname: Aoki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: So
authors.initials: S
authors.lastname: Kurita
authors.forename: Kenta
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sugimura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi