title: Hepatitis B virus reactivation in hepatitis B virus surface antigen negative patients receiving immunosuppression: A hidden threat.
abstract: OBJECTIVE
  To present the characteristics and the course of a series of anti-hepatitis B virus core antibody (HBc) antibody positive patients, who experienced hepatitis B virus (HBV) reactivation after immunosuppression.
  
  
  METHODS
  We retrospectively evaluated in our tertiary centers the medical records of hepatitis B virus surface antigen (HBsAg) negative patients who suffered from HBV reactivation after chemotherapy or immunosuppression during a 3-year period (2009-2011). Accordingly, the clinical, laboratory and virological characteristics of 10 anti-HBc (+) anti-HBs (-)/HBsAg (-) and 4 anti-HBc (+)/antiHBs (+)/HBsAg (-) patients, who developed HBV reactivation after the initiation of chemotherapy or immunosuppressive treatment were analyzed. Quantitative determination of HBV DNA during reactivation was performed in all cases by a quantitative real time polymerase chain reaction kit (COBAS Taqman HBV Test; cut-off of detection: 6 IU/mL).
  
  
  RESULTS
  Twelve out of 14 patients were males; median age 74.5 years. In 71.4% of them the primary diagnosis was hematologic malignancy; 78.6% had received rituximab (R) as part of the immunosuppressive regimen. The median time from last chemotherapy schedule till HBV reactivation for 10 out of 11 patients who received R was 3 (range 2-17) mo. Three patients (21.4%) deteriorated, manifesting ascites and hepatic encephalopathy and 2 (14.3%) of them died due to liver failure.
  
  
  CONCLUSIONS
  HBsAg-negative anti-HBc antibody positive patients can develop HBV reactivation even 2 years after stopping immunosuppression, whereas prompt antiviral treatment on diagnosis of reactivation can be lifesaving.
authors.affiliation: Kalliopi Zachou, Nikolaos K Gatselis, Stella Gabeta, Aggelos Stefos, Asterios Saitis, George N Dalekos, Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, 41110 Larissa, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Zachou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Sarantopoulos
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Gatselis
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Vassiliadis
authors.forename: Stella
authors.initials: S
authors.lastname: Gabeta
authors.forename: Aggelos
authors.initials: A
authors.lastname: Stefos
authors.forename: Asterios
authors.initials: A
authors.lastname: Saitis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Boura
authors.forename: George N
authors.initials: GN
authors.lastname: Dalekos
keywords: Anti-hepatitis B virus core antibody positivity; Hepatitis B; Immunosuppression; Occult hepatitis B virus infection; Rituximab
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