Clinical patterns associated with the concurrent detection of anti‐HBs and HBV DNA

Abstract

Simultaneous detection of anti-HBs and HBV DNA is a rare serological combination and has been described in acute and chronic HBV infection. To scrutinize viral and clinical patterns associated with concurrent detection of anti-HBs and HBV DNA. Simultaneous detection of anti-HBs and HBV DNA was observed in 64/1444 (4.4%) patients treated for HBV infection at the University Hospital of Essen from 2006 to 2016 (8 with acute, 20 with reactivated, and 36 chronic HBV infection). Clinical data and laboratory parameters were analyzed. Regions of the small hepatitis B surface antigen (SHB) and the reverse transcriptase (RT) were sequenced using next generation sequencing (NGS). Among the 64 patients with detectable HBV DNA and anti-HBs, 17 were HBsAg negative (HBsAg[-]), and two had acute liver failure. Patients with acute HBV infection had fewer genotype specific amino acid substitutions in the SHB region than patients with reactivated HBV infection (4 [4.5] vs 9 [16.25], P = 0.043). However, we could observe a significantly higher number of mutations in the a-determinant region when comparing chronically infected patients to patients with acute infection (0 [1] vs 1 [1], P = 0.044). The ratio of nonsynonymous to synonymous mutations (Ka/Ks) was on average >1 for the SHB region and <1 for the RT region. The Ka/Ks ratio (>1) in the SHB region indicates that anti-HBs might have exerted selection pressure on the HBsAg. In three cases the diagnosis of acute HBV infection would have been at least delayed by only focusing on HBsAg testing.

Breakthrough infection by hepatitis B virus in a vaccinated blood donor: An emerging threat for transfusion safety in low‐endemic countries?

“…We have previously reported the occurrence of infections in healthy blood donors in which HBV DNA coexisted with anti‐HBs, highlighting the importance of molecular tests for the prevention of transmission of this infection in our region 5 . The coexistence of anti‐HBs and HBV DNA is a rare phenomenon and has been observed in acute, chronic, and reactivated HBV infections 11 …”

“…5 The coexistence of anti-HBs and HBV DNA is a rare phenomenon and has been observed in acute, chronic, and reactivated HBV infections. 11 In several HBV-high endemic regions, blood donor screening includes the detection of anti-HBs. An optimal titer of anti-HBs (>200 mIU/mL) in blood components derived from donors with reactive anti-HBc and negative NAT DNA HBV has been set for the qualification of blood donors.…”

Hepatitis B virus reactivation in patients treated with immunosuppressive drugs: a practical guide for clinicians

“…Although this is less common than in those with isolated anti-HBc, it is important that all patients with anti-HBc positivity are screened for occult Anti-HBs = hepatitis B surface antibody; anti-HBe = hepatitis B 'e' antibody; anti-HBc = hepatitis B core antibody; HBeAg = hepatitis B 'e' antigen; HBsAg = hepatitis B surface antigen; HBV = hepatitis B virus; IVIG = intravenous immunoglobulin Apostolos Koffas, Grace E Dolman and Patrick TF Kennedy infection. 13 Paul et al recently showed that patients with resolved HBV infection receiving chemotherapy for haematological malignancies without antiviral prophylaxis, are at a decreased risk of HBVr when they have positive anti-HBs. 14 More recently, the virological marker Hepatitis B core-related antigen (HBcrAg) was reported to be associated with an increased risk of HBVr in HBsAg-negative and anti-HBc-positive subjects undergoing highrisk immunosuppressive regimens.…”

Detection of Hepatitis B Virus Genome with Mutations Outside the Major Hydrophilic Region in the Surface Antigen Isolated from Patients with Coexisting HBsAg and Anti-HBs

“…In serological markers of HBV infection, general theory considers that the antibody to HBsAg (anti-HBs) can neutralize HBsAg; therefore, it is generally agreed that there will be no simultaneous positive for both HBsAg and anti-HBs in routine clinical practice (14)(15)(16). However, the simultaneous presence of HBsAg and anti-HBs in chronic HBV carriers has been reported in previous studies (17,18).…”