Effects of Immunosuppressive Therapy on Viral Markers in Chronic Active Hepatitis B

Scullard, George; Smith, Coleman I.; Merigan, Thomas C.; Robinson, William S.; Gregory, Peter B.

doi:10.1016/s0016-5085(81)80002-9

Cited by 240 publications

(57 citation statements)

References 16 publications

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“…In one renal transplant recipient, the level of HBV DNA in serum increased dramatically in the posttransplant period after the patient received immunosuppressive therapy. This suggests that immunosuppression enhanced viral replication as previously ,observed (30)(31)(32)(33)(34)(35). Although the time of contact did not always correlate with the time of highest serum HBV DNA, this patient transmitted HBV to nine other individuals.…”

Section: Discussionsupporting

confidence: 69%

“…ANTICENEMIA The results of DNA hybridization experiments with serum from 35 Greek patients are listed in Table 1 and were corroborated by two independent observers, both of whom were blinded as to clinical details regarding the patients at the time of reading the autoradiograms. The patients were divided into subgroups based on HBeAg/ anti-HBe status ( Table 1).…”

Section: Greek Patients With Chronic Hbsagmentioning

confidence: 82%

“…PATIENT POPULATIONS AND SEROLOGICAL STUDIES Sera from four groups of patients, stored at -2O"C, were studied. Group I was composed of 35 Greek patients whose sera contained HBsAg by conventional radioimmunoassay. This group contained a variety of HBVrelated chronic states including chronic carriers with normal liver by routine histology, patients with chronic persistent or chronic active hepatitis, carriers with cirrhosis, and several patients with cirrhosis and hepatocellular carcinoma.…”

Section: Methodsmentioning

confidence: 99%

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Detection of Hepatitis B Virus DNA Directly in Human Serum by a Simplified Molecular Hybridization Test: Comparison to HBeAg/ Anti-HBe Status in HBsAg Carriers†

et al. 1983

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A simple, direct molecular hybridization test was employed to detect hepatitis B virus (HBV) DNA sequences in human serum. In 61 HBsAg carriers, many with HBV-related diseases (chronic persistent hepatitis, chronic active hepatitis, or posthepatitic cirrhosis), 28/28 (100%) who were HBeAg+ and 16/32 (50%) who were anti-HBe+ had HBV DNA sequences in their serum. Among 22 South African black patients with hepatocellular carcinoma, 7 (32%) had detectable HBV DNA in their serum but at reduced levels when compared to HBsAg carriers without hepatocellular carcinoma, suggesting that viral replication is suppressed or inactive in many hepatocellular carcinoma patients. Hybridization analysis also distinguished carriers with high, moderate, or low amounts of HBV DNA in serum. Ten to 20% of HBsAg+/HBeAg+ carriers showed high serum levels of HBV DNA but, surprisingly, a similar percentage of HBsAg+/anti-HBe+ carriers also showed relatively high serum levels of HBV DNA. Five patients who had undergone immunosuppression therapy and most of whom were on chronic hemodialysis had very high serum levels of HBV DNA, in the range observed during acute HBV infection. By epidemiologic analysis, two of these individuals were implicated in transmission of hepatitis to other hemodialysis patients, paramedical personnel, or intimate family contacts. Serum HBV DNA hybridization analysis identifies carriers with high serum levels of HBV irrespective of HBeAg/anti-HBe status and may define individuals with potentially high risk of transmitting infection to their immediate contacts. enhanced the study of hepatitis B virus (HBV)-related diseases through detection of specific HBV DNA sequences in human tissues. Recently, we and others reported the use of molecular hybridization to detect HBV DNA sequences in liver and hepatocellular carcinoma (1)(2)(3)(4)(5). This technique can also be applied to detect HBV DNA sequences in nucleic acid extracts of serum (6-9). The hybridization method has now been simplified to detect HBV DNA sequences directly in human serum.The objectives of this investigation were to compare immunologic markers of HBV infection with detection of HBV DNA in serum and to determine the relative viral load by direct measurement of HBV DNA sequences. Particular emphasis was placed on HBeAg/antiHBe status in relation to the presence or absence of HBV 285

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Section: Discussionsupporting

confidence: 69%

Section: Greek Patients With Chronic Hbsagmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

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Detection of Hepatitis B Virus DNA Directly in Human Serum by a Simplified Molecular Hybridization Test: Comparison to HBeAg/ Anti-HBe Status in HBsAg Carriers†

et al. 1983

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“…Clearance of HBsAg while immunosuppressed is unusual but has been recently reported (22). The influence of the episode of acute hepatitis in Patient 18 which was apparently unrelated to withdrawal of immunosuppression (11,23) on this favorable outcome is of considerable interest. The consequences of simultaneous acquisition of type B hepatitis and the institution of immunosuppression in the single patient dying of fulminant type B hepatitis remain speculative.…”

Section: Discussionmentioning

confidence: 90%

“…Serum concentrations of circulating HBsAg and hepatitis B core antigen (HBcAg) increase during treatment with prednisolone and azathioprine (10). Increased DNA polymerase activity has recently been documented in HBV carriers treated with shortterm corticosteroids (11).…”

mentioning

confidence: 99%

Natural History of Hepatitis B Virus Infection in Renal Transplant Recipients-A Fifteen-Year Follow-Up

et al. 1983

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Hepatitis B virus (HBV) markers were measured in 83 immunosuppressed renal transplant patients who were followed for periods of 2 to 15 years. Sixty-nine patients were negative for HBsAg before transplantation, of whom 14 were positive for anti-HBs. The remaining 14 patients were HBsAg positive prior to transplantation. Eighteen patients were identified as being HBsAg positive during the follow-up period. Four patients acquired primary type B hepatitis; one died of submassive hepatic necrosis and the remaining three became chronic HBV carriers with positive HBeAg, DNA polymerase, and HBV DNA. Several patterns of HBV expression were observed in HBsAg-positive patients. Four patients were HBsAg, HBeAg, DNA polymerase, and HBV DNA positive prior to transplantation, and these markers persisted. Reactivation of HBV replication occurred in eight patients, seven of whom were HBsAg positive and HBeAg and anti-HBe negative originally; one patient was anti-HBc positive. A single patient was HBsAg and anti-HBe positive and remained so for 22 months. The remaining previously HBsAg-positive patient is currently HBsAg negative. These serological data suggest that reactivation of HBV replication or continued hepatitis B virion replication occurs as commonly or more commonly than de nouo infection in renal transplant recipients. The presence of HBeAg in serum predisposes to long-term Dane particle expression in immunosuppressed patients, whereas anti-HBe-positive carriers may not always be susceptible to reactivation of HBV replication despite immunosuppression.Several viral infections are potentiated in immunocompromised hosts. Cytomegalovirus, herpes simplex, varicella-zoster, and Epstein Barr virus infection occur with increased frequency in immunosuppressed renal transplant recipients (1). Patients with chronic renal failure on maintainance hemodialysis and renal transplant recipients are particularly liable to chronic hepatitis B virus (HBV) infection (2, 3). Viral replication is favored in azotemic hemodialysis patients, and they are frequently hepatitis B e antigen (HBeAg) positive and HBV DNA polymerase positive (4).Reactivation of type B hepatitis may follow treatment with immunosuppressive drugs and chemotherapy. Reappearance of HBsAg in serum of HBsAg-negative

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Prolongation of the Prodrome to Acute Hepatitis B Infection by Corticosteroids

Johnson¹

1983

Arch Intern Med

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Effects of Immunosuppressive Therapy on Viral Markers in Chronic Active Hepatitis B

Cited by 240 publications

References 16 publications

Detection of Hepatitis B Virus DNA Directly in Human Serum by a Simplified Molecular Hybridization Test: Comparison to HBeAg/ Anti-HBe Status in HBsAg Carriers†

Detection of Hepatitis B Virus DNA Directly in Human Serum by a Simplified Molecular Hybridization Test: Comparison to HBeAg/ Anti-HBe Status in HBsAg Carriers†

Natural History of Hepatitis B Virus Infection in Renal Transplant Recipients-A Fifteen-Year Follow-Up

Prolongation of the Prodrome to Acute Hepatitis B Infection by Corticosteroids

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