Hepatitis B virus reactivation sustained by a hepatitis B virus surface antigen immune-escape mutant isolate in a patient who was hepatitis B core antibody positive during treatment with sofosbuvir and velpatasvir for hepatitis C virus infection: a case report

Luca Foroghi Biland,Valentina Svicher,Loredana Sarmati,Massimo Andreoni,Elisabetta Teti,Carlotta Cerva,Romina Salpini,Vincenzo Malagnino,Ludovica Ferrari,Adele Gentile,Marianna Aragri

doi:10.1186/s13256-019-2232-3

Luca Foroghi Biland, Valentina Svicher + Show 9 more

Open Access

https://doi.org/10.1186/s13256-019-2232-3

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Abstract

BackgroundAlthough several cases of hepatitis B virus reactivation have been described in patients with a history of hepatitis B virus infection while undergoing treatment for hepatitis C virus infection with direct acting antivirals, the question of whether hepatitis B virus surface antigen immune-escape mutations might play a role has not been addressed so far.Case presentationWe report a case of hepatitis B virus reactivation in a Caucasian patient infected with hepatitis C virus during treatment with sofosbuvir and velpatasvir. A 50-year-old man with a genotype 1a hepatitis C virus infection was considered for therapy. His serological profile was hepatitis B virus surface antigen-negative, hepatitis B virus core antibody-positive, hepatitis B virus surface antibody-negative, and anti-hepatitis D virus-positive. The detection of hepatitis B virus deoxyribonucleic acid (DNA) indicated active viral replication during the direct acting antiviral treatment that spontaneously returned to undetectable levels after treatment completion. Starting from week 12 after the end of treatment, hepatitis B virus surface antibody titers and hepatitis B virus e antibody developed. Sequencing analysis revealed the hepatitis B virus genotype D3 and the presence of two relevant immune-escape mutations (P120S and T126I) in the major hydrophilic region by analyzing the S region.ConclusionsWe speculate that the presence of the hepatitis B virus surface antigen mutations, endowed with the enhanced capability to elude the immune response, could play a role in hepatitis B virus reactivation. This observation confirms that occult hepatitis B infection should also be carefully monitored, through surveillance of the hepatitis B virus viral load before and during direct acting antiviral treatment of hepatitis C virus.

Highlights

Several cases of hepatitis B virus reactivation have been described in patients with a history of hepatitis B virus infection while undergoing treatment for hepatitis C virus infection with direct acting antivirals, the question of whether hepatitis B virus surface antigen immune-escape mutations might play a role has not been addressed so far.Case presentation: We report a case of hepatitis B virus reactivation in a Caucasian patient infected with hepatitis C virus during treatment with sofosbuvir and velpatasvir
occult HBV infection (OBI), defined by the detection of HBV deoxyribonucleic acid (DNA) in hepatocytes or in the serum of patients who are hepatitis B virus surface antigen (HBsAg)-negative, can contribute to accelerated evolution of cirrhosis or the development of hepatocellular carcinoma (HCC) in patients coinfected with hepatitis C virus (HCV) [3, 4]
To the best of our knowledge, we are the first to report a case of HBV reactivation (HBVr) characterized by the emergence of viral strains with immune-escape mutations in a patient coinfected with HCV with isolated anti-HBc positivity and on a successful treatment with the latest generation of direct acting antivirals (DAAs) sofosbuvir and velpatasvir

Summary

Conclusions

We speculate that the presence of the hepatitis B virus surface antigen mutations, endowed with the enhanced capability to elude the immune response, could play a role in hepatitis B virus reactivation.

Background

Discussion and conclusions