Cases reported • Hepatitis B

1/26. Clearance of HCV rna in a chronic hepatitis c virus-infected patient during acute hepatitis b virus superinfection.

The routes of hepatitis b virus and hepatitis c virus transmission are quite similar and coexistence of both viruses in one patient is not a rare phenomenon. Until now, the natural course of liver diseases induced by coinfections has not been well documented and the mechanisms of interaction between the two viruses and the human host have not been fully clarified. We report the case of a patient suffering from chronic hepatitis due to hepatitis c virus who developed an acute hepatitis b virus superinfection. serum hepatitis c virus ribonucleic acid became undetectable by reverse transcriptase/polymerase chain reaction at diagnosis of acute hepatitis b virus infection. At the same time, there was a striking increase in the serum concentrations of the antibodies against C22 and C33c hepatitis c virus antigens. Four months after clinical resolution of the acute hepatitis, hepatitis B surface antigen was undetectable in serum and three months later antibodies against hepatitis B surface antigen appeared. Two years after acute hepatitis b virus infection, the patient has had no relapse of markers for viral replication of hepatitis b virus. transaminases are within the reference range and hepatitis c virus ribonucleic acid is undetectable in both serum and liver tissue. We hypothesize that acute hepatitis b virus infection stimulated a specific humoral response against hepatitis c virus as well as triggering non-specific defense mechanisms which finally eliminated both viruses.

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keywords = superinfection
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2/26. Severe hepatitis due to HBV-HDV coinfection.

Quadruple hepatic infections are not uncommon in human immunodeficiency virus (HIV) infected patients. Hepatotropic viruses behave differently in immunocompromised patients resulting in varied clinical and serological outcomes. Delta hepatitis, an important cause of acute hepatitis in intravenous drug abusers (IVDAs) and HIV-infected patients, can present as coinfection or superinfection clinically, which influences the prognosis. Prevention of hepatitis D virus (HDV) coinfection is possible with hepatitis b virus (HBV) vaccination. No definitive medical treatment for HDV infection is known to be successful. Interestingly, liver transplantation carries a higher success rate in HDV/HBV infection then in HBV infection alone.

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keywords = superinfection
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3/26. Reactivation of hepatitis c virus superinfection in a patient seropositive for hepatitis B e antigen.

During the course of chronic hepatitis b virus (HBV) infection, a patient seropositive for hepatitis B e antigen experienced four episodes of acute hepatic necroinflammation. serum HBV-dna concentration elevated immediately before the first and third exacerbations, whereas serum hepatitis c virus (HCV) rna was detected during the second and fourth exacerbations. The nucleotide sequences of HCV hypervariable region derived from samples of the two exacerbations were identical. Interestingly, "de novo" seroconversion of anti-HCV antibody (Abbott HCV EIA 3.0) followed by reversion occurred in both the second and fourth exacerbations with low sample/cutoff ratios. Immunoblot analysis using a line-immunoassay (Inno-LIA HCV Ab III) revealed a single positive band (C1) developing after the second exacerbation. These data indicate that the second exacerbation in this patient was caused by newly acquired acute HCV superinfection, whereas the fourth exacerbation was likely due to reactivation of the previous HCV infection. Recognition of such a case suggests that the presence of de novo seroconversion of anti-HCV may indicate either reactivation or acute superinfection of HCV in a patient seropositive for hepatitis B e antigen.

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keywords = superinfection
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4/26. Single nucleotide insertion in the 5'-untranslated region of hepatitis c virus with clearance of the viral rna in a liver transplant recipient during acute hepatitis b virus superinfection.

hepatitis c virus (HCV) infection is an important etiology in patients undergoing orthotopic liver transplantation (OLT) world-wide. Antiviral therapy-related clearance of HCV rna may occur both in patients with chronic HCV infection and in transplanted patients for HCV-related liver cirrhosis, but the role of the 5'-untranslated region (UTR) of HCV containing the internal ribosome entry site (IRES), which directs the translation of the viral open reading frame has not hitherto been evaluated. We studied the 5'-UTR in an HCV-infected recipient of a liver graft that showed spontaneous clearance of HCV rna during an acute hepatitis b virus (HBV) superinfection. Sequencing of the 5'-UTR of HCV showed a nucleotide A insertion at position 193 of the IRES.

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5/26. hepatitis c virus eradication associated with hepatitis b virus superinfection and development of a hepatitis b virus specific T cell response.

BACKGROUND/AIMS: Specific T cell responses during acute hepatitis B and during chronic hepatitis c have been described in detail. However, the T cell responses during the rare setting of acute hepatitis b virus (HBV) infection in the course of chronic hepatitis c that eventually lead to clearance of both viruses are completely unknown. methods: We analyzed the virus specific CD4+ and CD8+ T cell response during an acute HBV superinfection in a patient with chronic hepatitis c. RESULTS: The patient eliminated hepatitis c virus (HCV)-rna and HBV-dna from serum soon after the clinical onset of acute hepatitis B. The HBV specific T cell response found in this patient corresponds to the typical response that has been described in acute hepatitis B without chronic HCV infection. In contrast the hepatitis c specific immune response was similar to that generally found in chronic hepatitis c despite the fact that the patient also eliminated HCV-rna. CONCLUSIONS: We hypothesize that the acute HBV infection induced a HBV specific T cell response which was associated with elimination HBV dna and HCV-rna, the latter possibly by bystander mechanisms, e.g. via secretion of cytokines. If such a non-specific bystander mechanism which has proven to be effective in the experimental setting and which is formally described here for a single patient can be shown to be a more general phenomenon, it may support the approach with new antiviral strategies, e.g. the induction of non-specific defense mechanisms against HCV.

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6/26. Effect of acute self-limited hepatitis c virus (HCV) superinfection on hepatitis B virus (HBV)-related cirrhosis. Virological features of HBV-HCV dual infection.

We investigated the virological impact of acute hepatitis c virus (HCV) superinfection on two patients with hepatitis b virus (HBV)-related cirrhosis. In both patients, chronic HBV-infection persisted while acute HCV infection resolved spontaneously. HBV dna was transiently suppressed in both patients but increased with HCV resolution. In Case 1 (HBeAg-positive; wild type of basic core promoter [BCP] and precore [PreC]), fluctuations of HBV dna and HBeAg state were accompanied by mutations of the BCP and PreC. In Case 2 (HBeAg-negative; mutant type of the BCP and PreC), changes in HBV dna levels were associated with mutations of PreC. In both cases, mutant PreC changed to the wild type upon HCV resolution, and no nucleotide A insertion at position 193 of the HCV 5'-untranslated region, which influences HCV spontaneous clearance, was detected. The putative dna-binding motif in the HCV core was SPRG (amino acids 99-102). HCV infection was associated with changes in the nucleotide sequences of the binding site for the nuclear receptor family in HBV enhancer 2 (Enh2) including the BCP rather than Enh1. Our results suggest that the impact of acute HCV infection on chronic HBV infection varies according to HBV virological state.

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7/26. Acute hepatitis b virus superinfection in a Taiwanese patient with chronic hepatitis c.

Acute hepatitis B superimposed on patients with chronic hepatitis c is a rarely observed event, especially in hepatitis b virus (HBV)-prevalent areas where chronic HBV infection is usually acquired perinatally or at early infancy. The interactive relationship between HBV and hepatitis c virus (HCV) and clinical outcome in such patients remains controversial. We report a case of acute HBV superinfection which occurred during follow-up of chronic HCV infection in a 66-year-old woman. The patient developed hepatic decompensation at the acute stage. Unlike previously reported cases in Taiwanese, in which the patient either died of fulminant hepatic failure or subsequently relapsed with HCV viremia, this chronic hepatitis c patient with acute HBV superinfection had virologic remission with undetectable HBV dna and HCV rna during 9 months of follow-up.

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8/26. Hepatitis delta superinfection during alpha-interferon treatment for hepatitis B.

Alpha-interferon (IFN) has been used to treat hepatitis b virus carriers with chronic hepatitis delta virus superinfection. Although the drug inhibits hepatitis delta virus replication during administration, long-term clearance of the virus has not been obtained in most patients. The effectiveness of alpha-interferon on chronic HDV infection is therefore questionable. No data are available on acute infection. We report the case of a young, immunocompetent HBsAg carrier in whom hepatitis delta virus superinfection occurred while he was receiving alpha-interferon in order to reduce high level HBV replication, and followed a peculiar course.

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keywords = superinfection
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9/26. Sustained remission of chronic hepatitis c after acute hepatitis B superinfection.

We observed acute HBV superinfection on chronic HCV genotype 1 infection in a 29-y-old injection drug user. On presentation HCV-rna was already negative and remained so for at least 7 months thereafter. We speculate that clearance of HCV-HBV coinfected cells by HBV-specific immunity might be a mechanism of HCV eradication.

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10/26. hepatitis delta virus super-infection in a co-infected patient with the human immunodeficiency virus type 1 and a surface antigen-negative hepatitis b virus variant.

Human immunodeficiency virus infection has a major impact on the natural history of chronic hepatitis B and favours the emergence of viral mutants. We describe an acute hepatitis D virus superinfection in an hiv-1-infected patient under HAART treatment who was previously a chronic carrier of a surface negative HBV variant resistant to lamivudine.

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