Longstanding, undiagnosed, highly replicative hepatitis B virus reactivation in the presence of high levels of anti-HBs antibodies.

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Laboratory medicine Pub Date : 2025-09-08 DOI:10.1093/labmed/lmaf003

Mahdi Ouafi, Alexandre Réguème, Stéphane Chevaliez, Emmanuel Faure, Aurélie Guigon, Magali Bouvier-Alias, Valérie Canva, Didier Hober, Laurence Bocket, Enagnon Kazali Alidjinou

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Abstract

Introduction: Kidney transplant recipients are among the populations at risk for Hepatitis B Virus (HBV) reactivation, and close monitoring is needed for its early detection.

Methods: We describe a case of HBV reactivation in a patient who underwent kidney transplantation more than 30 years ago, with a known serological profile of past HBV infection.

Results: Reactivation occurred as a highly replicative infection that went undiagnosed for 7 years due to negative results for HB surface antigen (HBsAg) and high levels of anti-HBs antibodies. Viral genome sequencing showed a high number of mutations in the major hydrophilic region of HBsAg that could explain such a profile.

Discussion: This case highlights the usefulness of frequent and systematic HBV viral load testing in patients at risk of reactivation, with anti-hepatitis B core antibodies, regardless of HBsAg detection, aminotransferases, and anti-HBs antibody levels.

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在存在高水平的抗hbs抗体的情况下，长期存在的、未确诊的、高度复制的乙型肝炎病毒再激活。

肾移植受者是乙型肝炎病毒（HBV）再激活的高危人群之一，需要密切监测以早期发现。方法：我们描述了一例30多年前接受肾移植的患者HBV再激活，既往HBV感染的血清学特征已知。结果：由于HB表面抗原（HBsAg）阴性和高水平的抗hbs抗体，再激活以高度复制感染的形式发生，7年未被诊断出来。病毒基因组测序显示，在HBsAg的主要亲水性区域有大量突变，这可以解释这种情况。讨论：该病例强调了对有再激活风险的患者进行频繁和系统的HBV病毒载量检测的有效性，这些患者具有抗乙型肝炎核心抗体，无论HBsAg检测、转氨酶和抗乙型肝炎抗体水平如何。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Laboratory medicine

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