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Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu

Yıl 2017, Cilt: 74 Sayı: 4, 341 - 346, 01.12.2017

Öz

Kronik hepatit B, siroz ve hepatoselüler kanser gibi ciddi ve ölümcül hastalıklara neden olabilir. Kronik hepatit B hastalarında genellikle HBsAg varlığını devam ettirir. Spontan ya da tedavi altında Anti-HBs serokonversiyonu nadir de olsa görülebilir ve tedavi altında ise tedaviyi sonlandırma kriteri olarak düşünülür. Bu olgu sunumunda, Anti-HBs pozitifliği olan ancak siroz olduğunu bilmeyen 63 yaşındaki erkek hastadan bahsedilmiştir. Hasta polikliniğimize uzun yıllardır yaptırmadığı takiplerine tekrar başlamak için başvurdu. İlk muayenesinde 20 yıldır hepatit B hastası olduğu ve 2 yıl tedavi aldığı sonrasında takiplerini bıraktığı öğrenilmiştir. Fizik muayenesi normal olan hastanın yapılan kan tahlillerinde Anti-HBs’nin pozitif olduğu ve trombositopenisi olduğu tespit edilmiştir. Hastanın yapılan radyolojik incelemelerinde batın ultrasonografi USG bulgularının siroz ile uyumlu olduğu görülmüştür. Anti-HBs pozitif olan hastanın siroz etiyolojisi açısından incelemek amacıyla özgeçmişi irdelendiğinde; 19 yıl önce yapılan biyopsinin siroz olarak rapor edildiği görülmüştür. Hastanın siroz nedeninin hepatit B olduğu ve siroz hastalığı geliştikten sonra HBsAg/Anti-HBs serokonversiyonu oluştuğu anlaşılmıştır. Daha önce interferon tedavisi alan ve HBV-DNA’sı düşük titre de pozitif olarak devam eden hastaya tenefovir tedavisi başlanmıştır. Siroz etiyolojisi araştırılan hastalarda Anti-HBs pozitifliği klinisyeni Hepatit B hastalığından uzaklaştırabilir. Hikayesi derinleştirilmeyen hastalar yanlış tanı konulmasına neden olabilir. Siroz etiyolojisi araştırılan hastalarda herhangi bir neden bulunamazsa ve hasta Anti-HBs pozitif ise HBV-DNA testi yapılması akılda tutulmalıdır. Literatürde benzer şekilde siroz hastalığı geliştikten sonra HBsAg/Anti-HBs serokonversiyonu görülen hasta ile ilgili yayın bulunmadığından bu olgu sunulmuştur

Kaynakça

  • Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012;30:2212–9. doi:10.1016/j. vaccine.2011.12.116.
  • Lok ASF. Hepatitis B infection: Pathogenesis and management. J Hepatology 2000;32: 89–97. doi: 10.1016/S0168-8278(00)80418-3.
  • Torbenson M, Thomas DL. Occult hepatitis B. Lancet Infectious Diseases 2002;2: 479–86. doi:10.1016/ S1473-3099(02)00345-6.
  • Chu CM. Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol 2000;15:25-30. doi: 10.1046/j.1440-1746.2000.02097.x.
  • Chen YC, Sheen IS, Chu CM, Liaw YF. Prognosis following spontaneous HBsAg seroclearance in chronic hepatitis B patients with or without concurrent infection. Gastroenterology 2002;123:1084–9, gast.2002.36026.
  • Chu CM, Liaw YF. Hepatitis B surface antigen seroclearance during chronic HBV infection. Antivir Ther 2010;15: 133–43. doi: 10.3851/IMP1497.
  • Liaw YF, Sheen IS, Chen TJ, Chu CM, Pao CC. Incidence, determinants and significance of delayed clearance of serum HBsAg in chronic hepatitis B virus infection: a prospective study. Hepatology 1991;13:627-31. doi: 10.1002/hep.1840130403.
  • Tseng TC, Liu CJ, Yang HC, Su TH, Wang CC, et al. Determinants of spontaneous surface antigen loss in hepatitis B e antigen-negative patients with a low viral load. Hepatology 2012;55:68–76. doi: 10.1002/hep.24615.
  • Kato Y, Nakao K, Hamasaki K, Kato H, Nakata K, Kusumoto Y et al. Spontaneous loss of hepatitis B surface antigen in chronic carriers, based on a long-term follow-up study in Goto Islands, Japan. J Gastroenterol 2000;35:201-5. doi: 10.1007/ s005350050331.
  • Nam SW, Jung JJ, Bae SH, Choi JY, Yoon SK, Cho SH et al. Clinical outcomes of delayed clearance of serum HBsAG in patients with chronic HBV infection. Korean J Intern Med 2007;22(2):73-8. doi: http:// dx.doi.org/10.3904/kjim.2007.22.2.73.
  • Ferreira SC, Chachá SG, Souza FF, Teixeira AC, Santana RC, Villanova MG, et al. Factors associated with spontaneous HBsAg clearance in chronic hepatitis B patients followed at a university hospital. Ann Hepatol 2014;13(6):762-70.
  • Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007;45:507-39. doi: 10.1002/hep.21513.
  • Alward WL, McMahon BJ, Hall DB, Heyward WL, Francis DP, Bender TR. The long-term serological course of asymptomatic hepatitis B virus carriers and the development of primary hepatocellular carcinoma. J Infect Dis 1985;151:604-9. doi: 10.1093/infdis/151.4.604.
  • Fattovich G. Natural history and prognosis of hepatitis B. Semin Liver Dis 2003;23:47–68. doi: 10.1055/s-2003-37590.
  • Viral Hepatitle Savaşım Derneği (VHSD). Erişim tarihi: 5 Aralık 2015. Available from: http://www. vhsd.org.
  • Carey I, Harrison PM. Monotherapy versus combination therapy for the treatment of chronic hepatitis B. Expert Opin Investig Drugs 2009;18:1655- 66. doi: 10.1517/13543780903241599.
  • Chen CJ, Yang HI, Iloeje UH, REVEAL-HBV Study Group. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology 2009;49:72-84. doi: 10.1002/hep.22884
  • Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med 2002;347:168-74. doi: 10.1056/NEJMoa013215
  • Harris RA, Chen G, Lin WY, Shen FM, London WT, Evans AA. Spontaneous clearance of high- titer serum HBV DNA and risk of hepatocellular carcinoma in a Chinese population. Cancer Causes Control 2003;14:995-1000.
  • Fried MW, Piratvisuth T, Lau GK, Marcellin P, Chow WC, Cooksley G, et al. HBeAg and hepatitis B virus DNA as outcome predictors during therapy with peginterferon alfa-2a for HBeAg-positive chronic hepatitis B. Hepatology 2008;47:428-34. doi: 10.1002/hep.22065.
  • Idilman R, Cinar K, Seven G, Bozkus Y, Elhan A, Bozdayi M, et al. Hepatitis B surface antigen seroconversion is associated with favourable long- term clinical outcomes during lamivudine treatment in HBeAg-negative chronic hepatitis B patients. J Viral Hepat 2012;19:220–6. doi: 10.1111/j.1365- 2893.2011.01542.x. Epub 2011 Oct 19.
  • Fasano M, Lampertico P, Marzano A, Di Marco V, Niro GA, Brancaccio G, et al. HBV DNA suppression and HBsAg clearance in HBeAg negative chronic hepatitis B patients on lamivudine therapy for over 5 years. J Hepatol 2012;56:1254–8. doi: 10.1016/j. jhep.2012.01.022. Epub 2012 Feb 16.
  • European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012;57:167–85. doi: http://dx.doi. org/10.1016/j.jhep.2012.02.010.
  • Marcellin P, Bonino F, Lau GK, Farci P, Yurdaydin C, Piratvisuth T, et al. Sustained response of hepatitis B e antigen-negative patients 3 years after treatment with peginterferon alpha- 2a. Gastroenterology 2009;136:2169–79. doi: 10.1053/j.gastro.2009.03.006. Epub 2009 Mar 19.
  • Marcellin P, Piratvisuth T, Brunetto M. Increasing rates of HBsAg clearance and seroconversion in patients with HBeAg-negative disease treated with peginterferon alfa-2a ± lamivudine: results of 5-year post-treatment follow up. J Hepatol 2009;50:336 doi: 10.1016/S0168- 8278(09)60926-0.

HBsAg/AntiHBs seroconversion in cirrhotic patient

Yıl 2017, Cilt: 74 Sayı: 4, 341 - 346, 01.12.2017

Öz

Chronic hepatitis B infection can lead to serious and mortal illnesses such as cirrhosis and hepatocellular carcinoma. HBsAg usually persists in chronic Hepatitis B patients. Spontaneous or being treated Anti-HBs seroconversion can be rarely observed and considered to be the endpoint of treatment if he is being trated. In this case study, it is mentioned that 63 years old patient who does not know that he has cirrhosis but Anti-HBs positive. The patient applied to our clinic to take some regular follow-ups which have not been taken for many years. In his first examination it was learned that the patient has been hepatises positive for 20 years and stopped follow-ups after taking two years medical treatment. The patient’s whose physical examination is normal and it was detected that Anti-HBs pozitive and thrombocytopenia in blood tests. It was show that abdominal ultrasonography findings conform with cirrhosis. When it was investigated patient’s earlier results with Anti-HBs positive to search in terms of cirrhosis etiology, his previous biopsy was reported as cirrhosis 19 years ago. The causes cirrhosis is hepatitis be HBsAg /Anti-HBs seroconversion developed after cirrhosis. The tenofovir treatment was started to patient who has low titer HBV DNA and treated with interferon previously. The Anti-HBs positivity can detract the specialists from hepatitis B infection when cirrhosis etiology is investigatedin patients. The patient whose previous anamnesis was not detailed can be misdiagnosis. HBVDNA test should considered when the cirrhosis etiology is investigated in Anti-HBs positive patient with cirrhosis. It was presented this case because there is no HBsAg/Anti-HBs seroconversion after cirrhosis published before.

Kaynakça

  • Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012;30:2212–9. doi:10.1016/j. vaccine.2011.12.116.
  • Lok ASF. Hepatitis B infection: Pathogenesis and management. J Hepatology 2000;32: 89–97. doi: 10.1016/S0168-8278(00)80418-3.
  • Torbenson M, Thomas DL. Occult hepatitis B. Lancet Infectious Diseases 2002;2: 479–86. doi:10.1016/ S1473-3099(02)00345-6.
  • Chu CM. Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol 2000;15:25-30. doi: 10.1046/j.1440-1746.2000.02097.x.
  • Chen YC, Sheen IS, Chu CM, Liaw YF. Prognosis following spontaneous HBsAg seroclearance in chronic hepatitis B patients with or without concurrent infection. Gastroenterology 2002;123:1084–9, gast.2002.36026.
  • Chu CM, Liaw YF. Hepatitis B surface antigen seroclearance during chronic HBV infection. Antivir Ther 2010;15: 133–43. doi: 10.3851/IMP1497.
  • Liaw YF, Sheen IS, Chen TJ, Chu CM, Pao CC. Incidence, determinants and significance of delayed clearance of serum HBsAg in chronic hepatitis B virus infection: a prospective study. Hepatology 1991;13:627-31. doi: 10.1002/hep.1840130403.
  • Tseng TC, Liu CJ, Yang HC, Su TH, Wang CC, et al. Determinants of spontaneous surface antigen loss in hepatitis B e antigen-negative patients with a low viral load. Hepatology 2012;55:68–76. doi: 10.1002/hep.24615.
  • Kato Y, Nakao K, Hamasaki K, Kato H, Nakata K, Kusumoto Y et al. Spontaneous loss of hepatitis B surface antigen in chronic carriers, based on a long-term follow-up study in Goto Islands, Japan. J Gastroenterol 2000;35:201-5. doi: 10.1007/ s005350050331.
  • Nam SW, Jung JJ, Bae SH, Choi JY, Yoon SK, Cho SH et al. Clinical outcomes of delayed clearance of serum HBsAG in patients with chronic HBV infection. Korean J Intern Med 2007;22(2):73-8. doi: http:// dx.doi.org/10.3904/kjim.2007.22.2.73.
  • Ferreira SC, Chachá SG, Souza FF, Teixeira AC, Santana RC, Villanova MG, et al. Factors associated with spontaneous HBsAg clearance in chronic hepatitis B patients followed at a university hospital. Ann Hepatol 2014;13(6):762-70.
  • Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007;45:507-39. doi: 10.1002/hep.21513.
  • Alward WL, McMahon BJ, Hall DB, Heyward WL, Francis DP, Bender TR. The long-term serological course of asymptomatic hepatitis B virus carriers and the development of primary hepatocellular carcinoma. J Infect Dis 1985;151:604-9. doi: 10.1093/infdis/151.4.604.
  • Fattovich G. Natural history and prognosis of hepatitis B. Semin Liver Dis 2003;23:47–68. doi: 10.1055/s-2003-37590.
  • Viral Hepatitle Savaşım Derneği (VHSD). Erişim tarihi: 5 Aralık 2015. Available from: http://www. vhsd.org.
  • Carey I, Harrison PM. Monotherapy versus combination therapy for the treatment of chronic hepatitis B. Expert Opin Investig Drugs 2009;18:1655- 66. doi: 10.1517/13543780903241599.
  • Chen CJ, Yang HI, Iloeje UH, REVEAL-HBV Study Group. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology 2009;49:72-84. doi: 10.1002/hep.22884
  • Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med 2002;347:168-74. doi: 10.1056/NEJMoa013215
  • Harris RA, Chen G, Lin WY, Shen FM, London WT, Evans AA. Spontaneous clearance of high- titer serum HBV DNA and risk of hepatocellular carcinoma in a Chinese population. Cancer Causes Control 2003;14:995-1000.
  • Fried MW, Piratvisuth T, Lau GK, Marcellin P, Chow WC, Cooksley G, et al. HBeAg and hepatitis B virus DNA as outcome predictors during therapy with peginterferon alfa-2a for HBeAg-positive chronic hepatitis B. Hepatology 2008;47:428-34. doi: 10.1002/hep.22065.
  • Idilman R, Cinar K, Seven G, Bozkus Y, Elhan A, Bozdayi M, et al. Hepatitis B surface antigen seroconversion is associated with favourable long- term clinical outcomes during lamivudine treatment in HBeAg-negative chronic hepatitis B patients. J Viral Hepat 2012;19:220–6. doi: 10.1111/j.1365- 2893.2011.01542.x. Epub 2011 Oct 19.
  • Fasano M, Lampertico P, Marzano A, Di Marco V, Niro GA, Brancaccio G, et al. HBV DNA suppression and HBsAg clearance in HBeAg negative chronic hepatitis B patients on lamivudine therapy for over 5 years. J Hepatol 2012;56:1254–8. doi: 10.1016/j. jhep.2012.01.022. Epub 2012 Feb 16.
  • European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012;57:167–85. doi: http://dx.doi. org/10.1016/j.jhep.2012.02.010.
  • Marcellin P, Bonino F, Lau GK, Farci P, Yurdaydin C, Piratvisuth T, et al. Sustained response of hepatitis B e antigen-negative patients 3 years after treatment with peginterferon alpha- 2a. Gastroenterology 2009;136:2169–79. doi: 10.1053/j.gastro.2009.03.006. Epub 2009 Mar 19.
  • Marcellin P, Piratvisuth T, Brunetto M. Increasing rates of HBsAg clearance and seroconversion in patients with HBeAg-negative disease treated with peginterferon alfa-2a ± lamivudine: results of 5-year post-treatment follow up. J Hepatol 2009;50:336 doi: 10.1016/S0168- 8278(09)60926-0.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Olgu Sunumu
Yazarlar

Muhammet Gülhan Bu kişi benim

Muhammet Fatih Topuz Bu kişi benim

Pınar Yıldız Gülhan Bu kişi benim

Olgun Öztürk Bu kişi benim

Serdar Gül Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 74 Sayı: 4

Kaynak Göster

APA Gülhan, M., Topuz, M. F., Gülhan, P. Y., Öztürk, O., vd. (2017). Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu. Türk Hijyen Ve Deneysel Biyoloji Dergisi, 74(4), 341-346.
AMA Gülhan M, Topuz MF, Gülhan PY, Öztürk O, Gül S. Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu. Turk Hij Den Biyol Derg. Aralık 2017;74(4):341-346.
Chicago Gülhan, Muhammet, Muhammet Fatih Topuz, Pınar Yıldız Gülhan, Olgun Öztürk, ve Serdar Gül. “Sirozlu Hastada HBsAg/AntiHBs Serokonversiyonu”. Türk Hijyen Ve Deneysel Biyoloji Dergisi 74, sy. 4 (Aralık 2017): 341-46.
EndNote Gülhan M, Topuz MF, Gülhan PY, Öztürk O, Gül S (01 Aralık 2017) Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu. Türk Hijyen ve Deneysel Biyoloji Dergisi 74 4 341–346.
IEEE M. Gülhan, M. F. Topuz, P. Y. Gülhan, O. Öztürk, ve S. Gül, “Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu”, Turk Hij Den Biyol Derg, c. 74, sy. 4, ss. 341–346, 2017.
ISNAD Gülhan, Muhammet vd. “Sirozlu Hastada HBsAg/AntiHBs Serokonversiyonu”. Türk Hijyen ve Deneysel Biyoloji Dergisi 74/4 (Aralık 2017), 341-346.
JAMA Gülhan M, Topuz MF, Gülhan PY, Öztürk O, Gül S. Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu. Turk Hij Den Biyol Derg. 2017;74:341–346.
MLA Gülhan, Muhammet vd. “Sirozlu Hastada HBsAg/AntiHBs Serokonversiyonu”. Türk Hijyen Ve Deneysel Biyoloji Dergisi, c. 74, sy. 4, 2017, ss. 341-6.
Vancouver Gülhan M, Topuz MF, Gülhan PY, Öztürk O, Gül S. Sirozlu hastada HBsAg/AntiHBs Serokonversiyonu. Turk Hij Den Biyol Derg. 2017;74(4):341-6.