Acute hepatitis B despite a previous high titer of anti-HBs.
BACKGROUND
Loss of HBsAg and development of surface and core antibodies represent clinical cure. However, recent evidence suggests that hepatitis B virus (HBV) persists in a latent state even in those with mounted protective antibodies. After significant immunosuppression, anti-HBs may decrease and HBsAg may reappear (reverse seroconversion). Reverse seroconversion of HBV has been observed in association with hematopoietic stem cell transplantation, renal transplantation, intensive chemotherapy, human immunodeficiency infection, or rituximab usage.


METHODS
We present here a case study of a patient with a previous high titer of anti-HBs who later developed HBV reactivation following intensive chemotherapy for leukemia.


CONCLUSIONS
We conclude that in immunosuppressed patients with a history of HBV infection may carry a risk for reverse seroconversion and monitoring anti-HBs levels may help recognising this risk.
Ozaras
Resat
R
Cerrahpasa Medical School, Istanbul University, 34098 Istanbul, Turkey.
Ar
Cem
C
Ongoren
Seniz
S
Mete
Bilgul
B
Tabak
Fehmi
F
Mert
Ali
A
Ozturk
Recep
R
J Viral Hepat. 2007 Jul;14(7):478-83
17576389
Biol Blood Marrow Transplant. 2007 Apr;13(4):463-8
17382252
Leuk Lymphoma. 2002 Nov;43(11):2159-63
12533042
Bone Marrow Transplant. 1989 Mar;4(2):207-8
2650792
Infection. 2006 Oct;34(5):282-4
17033754
Blood. 1996 Jan 15;87(2):818-26
8555508
Gastroenterology. 1988 Jan;94(1):151-6
3275563
Clin Infect Dis. 2005 Nov 1;41(9):1277-82
16206102
Transplantation. 2005 Mar 15;79(5):616-9
15753855
Nat Med. 1996 Oct;2(10):1104-8
8837608
J Clin Invest. 1994 Jan;93(1):230-9
8282792
AIDS. 2007 Mar 30;21(6):771-4
17413702
Leuk Lymphoma. 2004 Mar;45(3):627-9
15160930