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MORETTO F, CATHERINE FX, ESTEVE C, BLOT M, PIROTH L. Isolated Anti-HBc: Significance and Management. J Clin Med 2020; 9:E202. [PMID: 31940817 PMCID: PMC7019847 DOI: 10.3390/jcm9010202] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
Hepatitis B virus (HBV) infection is prevalent worldwide and is associated with dramatic levels of morbidity and mortality. Isolated anti-HBc (IAHBc) is a particular serological pattern that is commonly found in immunocompromised patients. There is ongoing debate regarding the management of patients with IAHBc. Herein, we summarize the current guidelines and the newest evidence. The frequency of IAHBc is variable, with a higher prevalence in some populations, such as persons living with HIV and others immunocompromised patients. The risk of HBV reactivation depends on host factors (including immunosuppression) and viral factors. It is now well established that immunocompromised patients can be classified into three groups for risk according to the type of immunosuppression and/or treatment. In patients at high risk, HBV therapy has to be considered systematically. In patients at moderate risk, the decision is based on the level of HBV DNA (preemptive treatment or monitoring and vaccination). In patients with low risk, HBV vaccination is another possible approach, although further studies are needed to assess the type of preemptive strategy.
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Affiliation(s)
- Florian MORETTO
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - François-Xavier CATHERINE
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - Clémentine ESTEVE
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - Mathieu BLOT
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
- INSERM CIC 1432, Module Plurithématique, University of Burgundy, 21079 Dijon, France
| | - Lionel PIROTH
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
- INSERM CIC 1432, Module Plurithématique, University of Burgundy, 21079 Dijon, France
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Jesus GJD, Oliveira LBD, Caliari JDS, Queiroz AAFL, Gir E, Reis RK. Dificuldades do viver com HIV/Aids: Entraves na qualidade de vida. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar e explorar as dimensões das dificuldades enfrentadas por Pessoas Vivendo com HIV/Aids no manejo da doença. Métodos Estudo descritivo, exploratório, de abordagem qualitativa desenvolvido em Serviços de Atendimento Especializado, com 26 pacientes. As entrevistas gravadas foram transcritas e posteriormente, processadas analisadas pela Classificação Hierárquica Descendente. Os achados foram fundamentados no Discurso do Sujeito Coletivo. Resultados Obteve-se cinco classes: “O preconceito intrafamiliar e seu impacto no enfrentamento da doença”; “Preconceito social: os impactos do macroambiente”; “As dificuldades em gerenciar o risco de transmissão do HIV/Aids e as implicações em parcerias”, “A manutenção de altas taxas de adesão ao tratamento do HIV/Aids: qualificando o serviço” e “ Promovendo a qualidade de vida em pessoas vivendo com HIV/Aids”. Conclusão As dificuldades experienciadas vão muito além da doença, tomando aspectos íntimos, centrais ligadas ao preconceito, que impede seu desenvolvimento pessoal, profissional e afetivo expandindo-se a macro-conceitos abstratos como qualidade de vida.
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Malahleha M, Ahmed K, Deese J, Nanda K, van Damme L, De Baetselier I, Burnett RJ. Hepatitis B virus reactivation or reinfection in a FEM-PrEP participant: a case report. J Med Case Rep 2015; 9:207. [PMID: 26411737 PMCID: PMC4586016 DOI: 10.1186/s13256-015-0679-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/18/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The FEM-PrEP trial was a pre-exposure prophylaxis clinical trial to test the safety and efficacy of Truvada (tenofovir disoproxil fumarate and emtricitabine) in the prevention of human immunodeficiency virus infection. Because Truvada can suppress hepatitis B virus replication, and withdrawal of Truvada can cause hepatic flares in patients with chronic hepatitis B, pre-enrollment screening included serological screening for hepatitis B virus markers. Women with chronic infections were not enrolled in the trial. Women found to be unprotected against hepatitis B were enrolled and offered three doses of hepatitis B vaccine. Reinfection and reactivation of previously resolved hepatitis B virus infections have been documented in immunosuppressed individuals but not in healthy individuals. We present the case of a participant enrolled in the FEM-PrEP clinical trial with baseline evidence of immunity against hepatitis B virus who subsequently developed acute hepatitis B. CASE PRESENTATION A 21-year-old Black non-pregnant woman was enrolled in the FEM-PrEP trial. She was human immunodeficiency virus-negative and a serological test for hepatitis B virus was negative. She had evidence of low levels of protection against hepatitis B virus and normal liver function. She had no hepatitis B vaccination history, thus it was concluded that she had post-infection immunity. At week 36 she presented with severely elevated liver enzyme levels that, upon further investigation, were a result of acute hepatitis B virus infection. The infection followed an asymptomatic course until full recovery of her liver enzymes a few weeks later. At study unblinding, the participant was found to be on the Truvada arm. Retrospective plasma drug level testing found low levels of study drugs from week 4. The participant remained human immunodeficiency virus-negative throughout the study. CONCLUSION Hepatitis B virus infection reactivation or reinfection is a rare phenomenon in healthy individuals. However, reactivations have been reported in patients being treated for chronic hepatitis B with the drugs contained in Truvada, after treatment had been withdrawn. This participant may have reactivated after stopping Truvada, or she may have reactivated spontaneously owing to relatively low levels of protective antibodies against hepatitis B. Alternatively, she may have been reinfected. Clinicians should be aware that hepatitis B virus reactivation or reinfection may cause elevated transaminases even in the presence of low baseline immunity.
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Affiliation(s)
- Mookho Malahleha
- Setshaba Research Centre, 2088 Block H, Soshanguve, Pretoria, 0152, South Africa.
| | - Khatija Ahmed
- Setshaba Research Centre, 2088 Block H, Soshanguve, Pretoria, 0152, South Africa.
| | - Jennifer Deese
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Kavita Nanda
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Lut van Damme
- Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA.
| | - Irith De Baetselier
- Institute of Tropical Medicine, Nationalestraat 155, Antwerpen, 2000, Belgium.
| | - Rosemary J Burnett
- HIV and Hepatitis Research Unit, Department of Virology, University of Limpopo, Medunsa Campus, PO Box 173, Medunsa, Pretoria, 0204, South Africa.
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Boyd A, Maylin S, Moh R, Gabillard D, Menan H, Mahjoub N, Danel C, Anglaret X, Eholié SP, Girard PM, Zoulim F, Delaugerre C, Lacombe K. Identifying patients infected with hepatitis B virus in sub-Saharan Africa: potential for misclassification. Diagn Microbiol Infect Dis 2015; 83:248-51. [PMID: 26283522 DOI: 10.1016/j.diagmicrobio.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/07/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022]
Abstract
Most research in sub-Saharan Africa establishes hepatitis B infection via one-time hepatitis B surface antigen (HBsAg) testing. Of 237 HIV-infected patients from two clinical trials testing HBsAg positive (MiniVidas®), 206 (86.9%) had validated serological tests using another assay (Architect). Discrepancies could be due to inactive infection, highlighting the importance of assessing hepatitis B virus infection phase.
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Affiliation(s)
- Anders Boyd
- INSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
| | - Sarah Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France; Université Paris-Diderot, Paris, France
| | - Raoul Moh
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Delphine Gabillard
- INSERM, U897, Epidémiologie-Biostatistique, Bordeaux, France; University of Bordeaux, ISPED, Bordeaux, France
| | - Hervé Menan
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherche sur le SIDA et les Maladies Opportunistes (CeDReS), Centre Hospitalier Universitaires (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Nadia Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France; Université Paris-Diderot, Paris, France
| | - Christine Danel
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire; INSERM, U897, Epidémiologie-Biostatistique, Bordeaux, France; University of Bordeaux, ISPED, Bordeaux, France
| | - Xavier Anglaret
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire; INSERM, U897, Epidémiologie-Biostatistique, Bordeaux, France; University of Bordeaux, ISPED, Bordeaux, France
| | - Serge Paul Eholié
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire; Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire; Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Pierre-Marie Girard
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabien Zoulim
- Centre de Recherche sur le Cancer de Lyon, Equipes 15 et 16, INSERM, Unité 1052, CNRS, UMR 5286, Lyon, France
| | - Constance Delaugerre
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France; INSERM U941, Paris, France; Université Paris-Diderot, Paris, France
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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Ruan J, Li HJ, Sun DX. Reactivation of hepatitis B virus. Shijie Huaren Xiaohua Zazhi 2014; 22:927-932. [DOI: 10.11569/wcjd.v22.i7.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reactivation of hepatitis B is characterized by the abrupt recurrence or the rise of hepatitis B virus (HBV) DNA in the serum of patients with previously inactive or resolved HBV infection, which frequently occurs during or after cytotoxic chemotherapy or immunosuppressive therapy; however, most of these cases are subclinical and only detected until activated liver disease. Several randomized controlled trials have shown that HBV reactivation can be prevented by antiviral prophylaxis. Thus, patients who are to receive cytotoxic chemotherapy or immunosuppressive therapy should be screened for present and previous hepatitis B infection, and hepatitis B surface antigen positive patients should receive antiviral prophylaxis.
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