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 Table of Contents  
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 91-92

Problems of hepatitis B core antibody testing in hepatitis B virus reactivation

1 Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
2 Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Date of Submission02-May-2015
Date of Acceptance09-Apr-2016
Date of Web Publication6-Sep-2016

Correspondence Address:
Yutaka Tsutsumi
Department of Hematology, Hakodate Municipal Hospital, 1–10–1, Minato-cho, Hakodate 041–8680
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2356-9115.189782

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How to cite this article:
Tsutsumi Y, Ito S, Shiratori S, Teshima T. Problems of hepatitis B core antibody testing in hepatitis B virus reactivation. Res Opin Anesth Intensive Care 2016;3:91-2

How to cite this URL:
Tsutsumi Y, Ito S, Shiratori S, Teshima T. Problems of hepatitis B core antibody testing in hepatitis B virus reactivation. Res Opin Anesth Intensive Care [serial online] 2016 [cited 2020 Jun 4];3:91-2. Available from: http://www.roaic.eg.net/text.asp?2016/3/2/91/189782

The importance of hepatitis B surface (HBs) antibodies in hepatitis B virus (HBV) reactivation was reported recently [1]. Having previously reported on the importance of hepatitis B core (HBc) antibodies and changes in HBs antibodies, it seems that, although the reported data are interesting, there has still not been sufficient discussion of antibody testing methods [2],[3],[4],[5],[6],[7]. Here, we report on the case of a patient initially judged to be negative on antibody testing, who was treated for relapsed mantle cell lymphoma and given an allogeneic bone marrow transplant from an unrelated donor. The patient was subsequently found to have hepatitis due to HBV reactivation, and tested positive for HBc antibodies when using a modified HBc antibody test method.

The patient was a 56-year-old man in whom generalized lymphadenopathy had been observed in 2006 and who had been diagnosed with diffuse large B-cell lymphoma following a lymph node biopsy. He went into remission after eight courses of R-CHOP chemotherapy, but the generalized lymphadenopathy reappeared in November 2008 and he was diagnosed after another lymph node biopsy. He was referred to us on 19 January 2009 and diagnosed with mantle cell lymphoma following a lymph node biopsy. The patient went into remission after six courses of cladribine, mitoxantrone, and rituximab. In September 2009, we performed an allogeneic bone marrow transplant from an unrelated donor. At this time, the patient tested negative for HBs antibodies, inconclusive for HBc antibodies (80% negative), and negative for HBV-DNA, and therefore HBV infection was not considered. The patient remained in remission after the transplant, but on 9 July 2011 he developed a noninduced liver disorder. Tests were performed suspecting a viral infection following a blood transfusion, yielding positive results for HBs antigens (171.8 mIU/ml), HBs antibodies (6.5 mIU/ml), HBc antibodies (100 mIU/ml), and HBV-DNA (4.3 log copy/ml), on which basis the patient was judged to have hepatitis caused by HBV. The liver function was improved by administering 0.5 mg entecavir. HBV-DNA tests were performed on the conserved serum after transfusion and on the previous blood donors, but the results were all negative. The antibody test method that has been used so far is the enzyme immunoassay method (AxSYM Assay, 2005; Abbot Laboratories, Chiba, Japan) [8]. Since 2014, when the chemiluminescence immunoassay method (Architect Assay, 2013; Abbott Laboratories) introduced at this hospital [9] was used to retest all the samples, there has been no change in the test results for HBV-DNA and HBs antibodies, but the HBc antibody tests became slightly positive (4.34–4.69 mIU/ml), showing that this was a case of an existing HBV infection.

The reactivation of HBV when administering Rituximab is an important side effect of B-cell lymphomas in HBV infection [1],[2],[3],[4],[5],[6],[7]. So far, we have reported on the importance of HBV virus antibody fluctuations in treatment using rituximab [2],[3],[4],[5],[6],[7]. Seto et al.[1] recently reported that HBs antibodies have an important bearing on reactivation of the HBV virus. Thus, while the importance of HBV virus antibodies is recognized, the variation between negative and positive tests for HBV antibodies depending on the HBV antibody test method as in this case is liable to shake the usefulness of this test to the core, and shows the importance of extracting results based on a uniform standard by integrating HBV antibody tests globally. To use HBV virus antibodies as a factor in predicting the reactivation of HBV it is desirable that antibody test methods be rapidly unified on a global scale, and that previous cases be reassessed using this unified test method.


Conflicts of interest

There are no conflicts of interest.

  References Top

Seto WK, Chan TS, Hwang YY, Wong DK, Fung J, Liu KS et al. Hepatitis B reactivation in patients with previous hepatitis B virus exposure undergoing rituximab-containing chemotherapy for lymphoma: a prospective study. J Clin Oncol 2014; 32:3736–3743.  Back to cited text no. 1
Tsutsumi Y, Yamamoto Y, Shimono J, Ohhigashi H, Teshima T. Hepatitis B virus reactivation with rituximab-containing regimen. World J Hepatol 2013; 5:612–620.  Back to cited text no. 2
Tsutsumi Y, Ogasawara R, Kamihara Y, Ito S, Yamamoto Y, Tanaka J et al. Rituximab administration and reactivation of HBV. Hepat Res Treat 2010; 2010:182067.  Back to cited text no. 3
Tsutsumi Y, Yamamoto Y, Tanaka J, Asaka M, Imamura M, Masauzi N. Prevention of hepatitis B virus reactivation under rituximab therapy. Immunotherapy 2009; 1:1053–1061.  Back to cited text no. 4
Tsutsumi Y, Kanamori H, Mori A, Tanaka J, Asaka M, Imamura M, Masauzi N. Reactivation of hepatitis B virus with rituximab. Expert Opin Drug Saf 2005; 4:599–608.  Back to cited text no. 5
Tsutsumi Y, Kawamura T, Saitoh S, Yamada M, Obara S, Miura T et al. Hepatitis B virus reactivation in a case of non-Hodgkin's lymphoma treated with chemotherapy and rituximab: necessity of prophylaxis for hepatitis B virus reactivation in rituximab therapy. Leuk Lymphoma 2004; 45:627–629.  Back to cited text no. 6
Tsutsumi Y, Tanaka J, Kawamura T, Miura T, Kanamori H, Obara S et al. Possible efficacy of lamivudine treatment to prevent hepatitis B virus reactivation due to rituximab therapy in a patient with non-Hodgkin's lymphoma. Ann Hematol 2004; 83:58–60.  Back to cited text no. 7
Taylor P, Pickard G, Gammie A, Atkins M. Comparison of the ADVIA Centaur and Abbott AxSYM immunoassay systems for a routine diagnostic virology laboratory. J Clin Virol 2004; 30 (Suppl 1):S11–S15.  Back to cited text no. 8
Sommese L, Sabia C, Paolillo R, Parente D, Capuano M, Iannone C et al. Screening tests for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus in blood donors: evaluation of two chemiluminescent immunoassay system. Scand J Infect Dis 2014; 46:660–664.  Back to cited text no. 9


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