Therapy of Occult Hepatitis B Virus Infection and Prevention of Reactivation

Raimondo, Giovanni; Filomia, Roberto; Maimone, S.

doi:10.1159/000360943

Cited by 19 publications

(9 citation statements)

References 38 publications

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“…Early steroid withdrawal and low maintenance level of tacrolimus makes effective DNHB prophylaxis possible [19]. Steroid was considered to increase the risk of post-LT HBV infection as it may stimulate the glucocorticoid responsive element present in the viral genome thus further up regulating HBV gene expression [20]. Lifelong prophylaxis, continuous monitoring, and compliance are imperative for success of the prophylactic regimen.…”

Section: Discussionmentioning

confidence: 99%

"De Novo Hepatitis B Prophylaxis in Pediatric Recipients of Hepatitis B Core Antibody-Positive Living Donor Liver Grafts"

Zakaria

2022

BJSTR

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The incidence of de novo hepatitis B virus (HBV) infection (DNHB) among patients receiving hepatitis B core antibody positive (HBcAb +ve) grafts is unacceptably high without prophylaxis (38%-100%). Therefore, it is of utmost importance to carry out effective prophylactic strategies. Two HBV naïve pediatric recipients in our center received HBcAb +ve liver grafts from living donors. One was a case of familial hypercholesterolemia and the other suffered from recurrent hepatoblastoma. Our prophylactic regimen in management of those recipients included pre-operative HBV vaccination targeting a hepatitis B surface antibody (HBsAb) titer >1000 IU/L and both intra and post-operative hepatitis B immunoglobulin (HBIg) supplementation targeting HBsAb titer of > 1000 IU/L in the first week then maintaining it above 200 IU/L in the following period. This was combined with NUCs in the first post-LT year. Both were stopped after the first post-LT year switching to HBV vaccine alone thereafter. Strict monitoring of HBsAb titer and HBV viral markers was undertaken. Untill the last visit of both patients (56-and 18-months post-LT), all their HBV markers were negative and their HBsAb titer was maintained at 1000 IU/L. We conclude that HBcAb positive grafts can be used safely in pediatric LT if an adequate prophylactic regimen is followed.

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Section: Discussionmentioning

confidence: 99%

"De Novo Hepatitis B Prophylaxis in Pediatric Recipients of Hepatitis B Core Antibody-Positive Living Donor Liver Grafts"

Zakaria

2022

BJSTR

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“…OBI reactivation has been reported in many clinical conditions affecting the immune system, and in association with a quite large number of immune-and/or chemotherapy treatments [6,34]. DAA-induced HCV cure appears to depict a different scenario with very uncommon clinical consequences.…”

Section: Discussionmentioning

confidence: 99%

Behaviour of Occult HBV Infection in HCV-Infected Patients under Treatment with Direct-Acting Antivirals

et al. 2018

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Background There is controversial data on possible occult HBV reactivation in HCV patients successfully treated with direct-acting antivirals (DAA). However, diagnosis of occult HBV infection (OBI) was not performed by gold standard procedures in any study. Methods By using several highly sensitive assays, we examined serially collected serum samples from 40 HBV-surface-negative DAA-treated HCV patients with OBI identified by testing liver biopsy specimens through nested-PCR technique. Serum samples were obtained at four time points from each patient (at baseline, at 4 weeks after starting, at the end and 12 weeks after stopping therapy) and tested for HBV DNA by nested-PCR and real-time PCR techniques. Results All tested serum samples were negative by both quantitative HBV surface antigen (HBsAg) and HBV core-related antigen assays. 26/40 patients were anti-HBs-positive and in all of them, the amount of this antibody was stable at the four time points evaluated. Serum HBV DNA was detected in 10 samples at baseline, in 6 samples 4 weeks after starting therapy, in 11 samples at the end of therapy and in 21 samples 12 weeks after stopping treatment ( P=0.001). Aminotransferase values dropped within the normal levels at week 4 of therapy and persisted normal over time in all cases. Conclusions A slight increase in the amount of HBV DNA 3 months after stopping DAA therapy was the only parameter showing a possible reappearance of HBV activity in OBI patients cured for a concomitant HCV infection, but it was insufficient to lead toward a virological reactivation capable of inducing liver injury.

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“…( 10) Some viral particles are transported back into the nucleus to increase the pool of cccDNA. (11,12) Within the RER, the viral particles are enveloped by a lipid membrane, which carries hepatitis B surface antigen (HBsAg). ( 13) Finally, the mature virions are released into the bloodstream, accompanied by empty particles that serve as decoys for the immune response.…”

Section: Hbv Life Cycle and Immune Responsementioning

confidence: 99%

Host and HBV Interactions and Their Potential Impact on Clinical Outcomes

Jose-Abrego,

Roman,

Laguna-Meraz

et al. 2023

Pathogens

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Hepatitis B virus (HBV) is a challenge for global health services, affecting millions and leading thousands to end-stage liver disease each year. This comprehensive review explores the interactions between HBV and the host, examining their impact on clinical outcomes. HBV infection encompasses a spectrum of severity, ranging from acute hepatitis B to chronic hepatitis B, which can potentially progress to cirrhosis and hepatocellular carcinoma (HCC). Occult hepatitis B infection (OBI), characterized by low HBV DNA levels in hepatitis B surface antigen-negative individuals, can reactivate and cause acute hepatitis B. HBV genotyping has revealed unique geographical patterns and relationships with clinical outcomes. Moreover, single nucleotide polymorphisms (SNPs) within the human host genome have been linked to several clinical outcomes, including cirrhosis, HCC, OBI, hepatitis B reactivation, and spontaneous clearance. The immune response plays a key role in controlling HBV infection by eliminating infected cells and neutralizing HBV in the bloodstream. Furthermore, HBV can modulate host metabolic pathways involved in glucose and lipid metabolism and bile acid absorption, influencing disease progression. HBV clinical outcomes correlate with three levels of viral adaptation. In conclusion, the clinical outcomes of HBV infection could result from complex immune and metabolic interactions between the host and HBV. These outcomes can vary among populations and are influenced by HBV genotypes, host genetics, environmental factors, and lifestyle. Understanding the degrees of HBV adaptation is essential for developing region-specific control and prevention measures.

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Therapy of Occult Hepatitis B Virus Infection and Prevention of Reactivation

Cited by 19 publications

References 38 publications

"De Novo Hepatitis B Prophylaxis in Pediatric Recipients of Hepatitis B Core Antibody-Positive Living Donor Liver Grafts"

"De Novo Hepatitis B Prophylaxis in Pediatric Recipients of Hepatitis B Core Antibody-Positive Living Donor Liver Grafts"

Behaviour of Occult HBV Infection in HCV-Infected Patients under Treatment with Direct-Acting Antivirals

Host and HBV Interactions and Their Potential Impact on Clinical Outcomes

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