title: Anti-HBs seroconversion during treatment with entecavir in a patient with chronic hepatitis B virus infection on hemodialysis.
abstract: Hepatitis B (HBV) virus infection is one of the most important causes of liver disease in patients with end-stage renal failure on hemodialysis. The natural history of chronic HBV infection acquired in childhood starts with an immune tolerant phase, followed by an immune clearance phase that may lead to the inactive carrier state or the development of chronic liver disease. Information on antiviral therapy administered very early during the immune clearance phase are lacking and no data exist on the treatment of early immune activation in the hemodialysis setting. This report describes the case of a patient affected by end-stage renal failure and HBeAg-positive chronic HBV virus infection treated very early during the immune clearance phase of HBV infection with an adjusted-dose of nucleoside analogue entecavir. The patient achieved a very rapid HBV-DNA undetectability, anti-HBe, and anti-HBs seroconversion. This is the first report of antiviral therapy with entecavir started during the immune reactive phase of HBV infection in a patient on hemodialysis and it suggests that antiviral treatment can enhance the effects of host immune activation resulting in biochemical, serological, and viral response, even in end-stage renal failure patients with partial immunodeficiency. Antiviral therapy with entecavir in the setting of hemodialysis was safe and well tolerated.
authors.affiliation: Clinica Malattie Infettive e Tropicali, Sapienza University of Rome, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Spaziante
authors.forename: Elisa
authors.initials: E
authors.lastname: Biliotti
authors.forename: Stefania
authors.initials: S
authors.lastname: Grieco
authors.forename: Donatella
authors.initials: D
authors.lastname: Palazzo
authors.forename: Rozenn
authors.initials: R
authors.lastname: Esvan
authors.forename: Gloria
authors.initials: G
authors.lastname: Taliani
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006510:Hepatitis B Antibodies / Q000097:blood*; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens; C413685:entecavir; D006147:Guanine
keywords: anti-HBs seroconversion; chronic hepatitis B; dialysis; entecavir; immune clearance