Virologica Sinica

, Volume 27, Issue 6, pp 368–371 | Cite as

A case of hepatitis B reactivation due to the hepatitis B virus escape mutant in a patient undergoing chemotherapy

Brief Report

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.

Keywords

Hepatitis B reactivation Escape mutant Lamivudine Malignancy 

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References

  1. 1.
    Dienstag J L, Schiff E R, Wright T L, et al. 1999. Lamivudine as initial treatment for chronic hepatitis b in the united states. N Engl J Med, 341(17): 1256–1263.PubMedCrossRefGoogle Scholar
  2. 2.
    Ferreira R, Carvalheiro J, Torres J, et al. 2012. Fatal hepatitis b reactivation treated with entecavir in an isolated anti-hbs positive lymphoma patient: A case report and literature review. Saudi J Gastroenterol, 18(4): 277–281.PubMedCrossRefGoogle Scholar
  3. 3.
    Fukushima N, Mizuta T, Tanaka M, et al. 2009. Retrospective and prospective studies of hepatitis b virus reactivation in malignant lymphoma with occult hbv carrier. Ann Oncol, 20(12): 2013–2017.PubMedCrossRefGoogle Scholar
  4. 4.
    Kim I K, Kim B G, Kim W, et al. 2012. Clinical prediction of failure of lamivudine prophylaxis for patients with hepatitis b infection undergoing cytotoxic chemotherapy for malignancy. Antimicrob Agents Chemother. 56(11): 5511–5519.PubMedCrossRefGoogle Scholar
  5. 5.
    Kondili L A, Osman H, Mutimer D. 2004. The use of lamivudine for patients with acute hepatitis b (a series of cases). J Viral Hepat, 11(5): 427–431.PubMedCrossRefGoogle Scholar
  6. 6.
    Lai C L, Chien R N, Leung N W, et al. 1998. A one-year trial of lamivudine for chronic hepatitis b. Asia hepatitis lamivudine study group. N Engl J Med, 339(2): 61–68.Google Scholar
  7. 7.
    Lee I C, Huang Y H, Chu C J, et al. 2010. Hepatitis b virus reactivation after 23 months of rituximab-based chemotherapy in an hbsag-negative, anti-hbs-positive patient with follicular lymphoma. J Chin Med Assoc, 73(3): 156–160.PubMedCrossRefGoogle Scholar
  8. 8.
    Lu M, Lorentz T. 2003. De novo infection in a renal transplant recipient caused by novel mutants of hepatitis b virus despite the presence of protective anti-hepatitis b surface antibody. J Infect Dis, 187(8): 1323–1326.PubMedCrossRefGoogle Scholar
  9. 9.
    Matsue K, Kimura S, Takanashi Y, et al. 2010. Reactivation of hepatitis b virus after rituximab-containing treatment in patients with cd20-positive b-cell lymphoma. Cancer, 116(20): 4769–4776.PubMedCrossRefGoogle Scholar
  10. 10.
    Miyake Y, Iwasaki Y, Takaki A, et al. 2008. Lamivudine treatment improves the prognosis of fulminant hepatitis b. Intern Med, 47(14): 1293–1299.PubMedCrossRefGoogle Scholar
  11. 11.
    Norder H, Couroucé A M, Coursaget P, et al. 2004. Genetic diversity of hepatitis B virus strains derived worldwide: genotypes, subgenotypes, and HBsAg subtypes. Intervirology, 47(6):289–309.PubMedCrossRefGoogle Scholar
  12. 12.
    Schmilovitz-Weiss H, Ben-Ari Z, Sikuler E, et al. 2004. Lamivudine treatment for acute severe hepatitis b: A pilot study. Liver Int, 24(6): 547–551.PubMedCrossRefGoogle Scholar
  13. 13.
    Tillmann H L, Hadem J, Leifeld L, et al. 2006. Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis b, a multicenter experience. J Viral Hepat, 13(4): 256–263.PubMedCrossRefGoogle Scholar
  14. 14.
    Yeo W, Chan T C, Leung N W, et al. 2009. Hepatitis b virus reactivation in lymphoma patients with prior resolved hepatitis b undergoing anticancer therapy with or without rituximab. J Clin Oncol, 27(4): 605–611.PubMedCrossRefGoogle Scholar
  15. 15.
    Yuen M F, Sablon E, Hui C K, et al. 2001. Factors associated with hepatitis b virus DNA breakthrough in patients receiving prolonged lamivudine therapy. Hepatology, 34(4 Pt 1): 785–791.PubMedCrossRefGoogle Scholar

Copyright information

© Wuhan Institute of Virology, CAS and Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.State Key Lab of Virology, Wuhan Institute of VirologyChinese Academy of SciencesWuhanChina
  2. 2.Department of Microbiology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  3. 3.Institute of VirologyUniversity Hospital of EssenEssenGermany

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