title: De Novo Superinfection of Hepatitis B Virus in an Anti-HBs Positive Patient with Recurrent Hepatitis C Following Liver Transplantation.
abstract: A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1×10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.
authors.affiliation: Hepatology Center, Bundang Jesaeng General Hospital, Seongnam, Korea.
authors.forename: Sung-Hae
authors.initials: SH
authors.lastname: Ha
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Park
authors.forename: Sun-Pyo
authors.initials: SP
authors.lastname: Hong
authors.forename: So-Ya
authors.initials: SY
authors.lastname: Back
authors.forename: Soo-Kyeong
authors.initials: SK
authors.lastname: Shin
authors.forename: Seung-Il
authors.initials: SI
authors.lastname: Ji
authors.forename: Soo-Ok
authors.initials: SO
authors.lastname: Kim
authors.forename: Wang-Don
authors.initials: WD
authors.lastname: Yoo
authors.forename: Bo-Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Sang-Jong
authors.initials: SJ
authors.lastname: Park
authors.forename: Zheng
authors.initials: Z
authors.lastname: Hong