title: A case of hepatitis B reactivation due to the hepatitis B virus escape mutant in a patient undergoing chemotherapy.
abstract: A 62-year-old man had chronic hepatitis B virus (HBV) infection and was diagnosed with liver cirrhosis. At the time of diagnosis the patient's virologic markers were positive for hepatitis B surface antigen (HBsAg), antibody to hepatitis B e antigen (anti-HBe) and antibody to hepatitis B core antigen (anti-HBc), while antibody to hepatitis B surface antigen (anti-HBs) and HBV DNA were negative. Later the patient received chemotherapy for malignancy. However, this was interrupted due to elevated liver enzymes. At the same time HBV DNA became positive. Lamivudine (LMV) therapy was administered immediately. However, the levels of serum aminotransferase and total bilirubin (TB) were still rising. Finally the patient died of fulminant hepatic failure. A sequence revealed HBV genotype C (HBsAg subtype adw) with immune escape mutations, F8L, S34L, F41S, G44V, F93C, V96G, L110I, C149Y and F161Y. The high morbidity and mortality of this complication is one of the major obstacles to completing the standard treatment for malignancy in HBV carriers. Therefore, the relative risk of antiviral prophylactic failure should be further assessed and the optimal strategy for antiviral prophylaxis in HBsAg-positive patients with oncologic and hematologic malignancies undergoing chemotherapy should be revised.
authors.affiliation: State Key Lab of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China. wucc@wh.iov.cn
authors.forename: Chunchen
authors.initials: C
authors.lastname: Wu
authors.forename: Hui
authors.initials: H
authors.lastname: Shi
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Mengji
authors.initials: M
authors.lastname: Lu
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Xinwen
authors.initials: X
authors.lastname: Chen
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy; D004279:DNA, Viral / Q000097:blood; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D006801:Humans; D057131:Immune Evasion; D019259:Lamivudine / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine