title: Spontaneous clearance of hepatitis B surface antigenemia after long-term hemodialysis.
abstract: Persistent infection with the hepatitis B virus (HBV) [as indicated by chronic HBV surface antigenemia (HBsAg)] continues to be an important problem in end-stage renal disease (ESRD) patients and specifically in those receiving maintenance hemodialysis (HD). Patients on HD who are HBsAg-positive for a year have little chance of ever eliminating the virus; hence, clearance of HBsAg is a rare event in long-term HD patients. We report the case of a 62-year-old diabetic woman who was HBsAg-positive at the time she started HD and remained so until 10 years later when she became HBsAg-negative followed by the development of hepatitis B surface antibody (anti-HBs). Prior to her seroconversion, she suffered a persistent infection of her HD arteriovenous graft (AVG) that required prolonged antibiotics and several surgical procedures. We speculate that this immune stimulation contributed to her seroconversion.
authors.affiliation: Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Patel
authors.forename: Divya
authors.initials: D
authors.lastname: Monga
authors.forename: Mohini
authors.initials: M
authors.lastname: Alexander
authors.forename: Sandeep
authors.initials: S
authors.lastname: Magoon
authors.forename: David
authors.initials: D
authors.lastname: Bernstein
authors.forename: John D
authors.initials: JD
authors.lastname: Wagner
authors.forename: Joseph
authors.initials: J
authors.lastname: Mattana
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016470:Bacteremia / Q000188:drug therapy; D005260:Female; D006509:Hepatitis B / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens