title: Delayed clearance of hepatitis B surface antigen and development of hepatitis B surface antibody in a chronic hemodialysis patient.
abstract: The introduction of hepatitis B vaccination and infection control in 1977 has greatly decreased the prevalence of hepatitis B. Currently, approximately 2.8% of the end-stage renal disease population is hepatitis B positive with a presence in 27.7% of the USA hemodialysis (HD) units according to the Dialysis Outcomes and Practice Patterns Study data. The behavior of hepatitis B infection differs significantly between immunocompetent and immunosuppressed hosts. Immunosuppressed hosts present more subtly with complications of chronic hepatitis B infection, being more challenging to detect. It is also well known that patients with chronic infection on HD have a small chance of clearing the virus. We report here a case of a hepatitis B positive HD patient who underwent spontaneous delayed serological clearance of hepatitis B surface antigen and development of immunity via appearance of hepatitis B surface antibody. This is a rare occurrence, and the few similar reported cases will be discussed.
authors.affiliation: Division of Nephrology, Greater Los Angeles Veterans Affairs Healthcare System; Department of Medicine, David Geffen School of Medicine at UCLA; Division of Nephrology, Olive View - UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Treger
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA; Division of Nephrology, Olive View - UCLA Medical Center; Department of Medicine, Division of Nephrology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Ramy M
authors.initials: RM
authors.lastname: Hanna
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA; Division of Nephrology, Olive View - UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Lee
authors.affiliation: Department of Nephrology, Kaiser Permanente, Panorama City, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Lopez
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA; Division of Nephrology, Olive View - UCLA Medical Center; Surgical Consultative Nephrology, UCLA David Geffen School of Medicine, Director UCLA Stone Center, Los Angeles, CA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Division of Nephrology, Greater Los Angeles Veterans Affairs Healthcare System; Department of Medicine, David Geffen School of Medicine at UCLA; Division of Nephrology, Olive View - UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Dalila
authors.initials: D
authors.lastname: Corry
mesh_terms: D006509:Hepatitis B; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006801:Humans; D007676:Kidney Failure, Chronic; D006435:Renal Dialysis
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens