Occult hepatitis B virus infection in a previously vaccinated injection drug user

Eleanor A. Powell, Sanam Razeghi, Stephen Zucker, Jason T. Blackard

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.

Original languageEnglish (US)
Article numbere34758
JournalHepatitis Monthly
Volume16
Issue number2
DOIs
StatePublished - Feb 20 2016

Fingerprint

Virus Diseases
Drug Users
Hepatitis B virus
Injections
Vaccination
Hepatitis B Surface Antigens
Chronic Hepatitis B
Hepatitis B Vaccines
Methicillin
Tricuspid Valve
Endocarditis
Antigen-Antibody Complex
Viral Load
Cardiomyopathies

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Infectious Diseases

Cite this

Powell, Eleanor A. ; Razeghi, Sanam ; Zucker, Stephen ; Blackard, Jason T. / Occult hepatitis B virus infection in a previously vaccinated injection drug user. In: Hepatitis Monthly. 2016 ; Vol. 16, No. 2.
@article{41e18f6c78a7432db88acc750c2966a1,
title = "Occult hepatitis B virus infection in a previously vaccinated injection drug user",
abstract = "Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.",
author = "Powell, {Eleanor A.} and Sanam Razeghi and Stephen Zucker and Blackard, {Jason T.}",
year = "2016",
month = "2",
day = "20",
doi = "10.5812/hepatmon.34758",
language = "English (US)",
volume = "16",
journal = "Hepatitis Monthly",
issn = "1735-143X",
publisher = "Kowsar Publishing Company",
number = "2",

}

Occult hepatitis B virus infection in a previously vaccinated injection drug user. / Powell, Eleanor A.; Razeghi, Sanam; Zucker, Stephen; Blackard, Jason T.

In: Hepatitis Monthly, Vol. 16, No. 2, e34758, 20.02.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Occult hepatitis B virus infection in a previously vaccinated injection drug user

AU - Powell, Eleanor A.

AU - Razeghi, Sanam

AU - Zucker, Stephen

AU - Blackard, Jason T.

PY - 2016/2/20

Y1 - 2016/2/20

N2 - Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.

AB - Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.

UR - http://www.scopus.com/inward/record.url?scp=84988432029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988432029&partnerID=8YFLogxK

U2 - 10.5812/hepatmon.34758

DO - 10.5812/hepatmon.34758

M3 - Article

C2 - 27148386

AN - SCOPUS:84988432029

VL - 16

JO - Hepatitis Monthly

JF - Hepatitis Monthly

SN - 1735-143X

IS - 2

M1 - e34758

ER -