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Open AccessArticle

Clinical and Virological Aspects of HBV Reactivation: A Focus on Acute Liver Failure

1
Institute of Virology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
2
Department of Bioinformatics and Computational Biophysics, University of Duisburg-Essen, 45117 Essen, Germany
3
Department of Gastroenterology and Hepatology, University Hospital Essen, 45147 Essen, Germany
4
German Center for Infection Research, DZIF, 38124 Braunschweig, Germany
5
Institute of Medical Virology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
*
Author to whom correspondence should be addressed.
Viruses 2019, 11(9), 863; https://doi.org/10.3390/v11090863
Received: 21 August 2019 / Revised: 3 September 2019 / Accepted: 10 September 2019 / Published: 16 September 2019
(This article belongs to the Special Issue Hepatitis B Virus Reactivation)
Hepatitis B virus (HBV) reactivation in immunosuppressed patients can cause considerable morbidity and mortality. The aim of our study was to evaluate factors associated with acute liver failure (ALF) in HBV reactivation. Clinical, laboratory, and virological data of 87 patients with HBV reactivation were analyzed retrospectively. Teno torque virus (TTV) plasma loads were measured as a measure of immune competence. HBV genomes isolated from 47 patients were analyzed by next-generation sequencing. A functional analysis of identified HBsAg mutants was performed. In patients with ALF the diagnosis was significantly later confirmed than in the non-ALF group. Patients diagnosed during immunosuppression had a milder clinical course compared to later diagnosed patients (p = 0.018, OR = 4.17). TTV viral loads did not differ significantly between the two groups. The HBV genomes isolated from ALF patients had higher viral complexity. A mutation in C-region of HBsAg (L216*), was associated with reduced HBsAg production and secretion. Patients diagnosed with HBV reactivation during immunosuppression had a milder clinical course compared to patients diagnosed during immune reconstitution. ALF was associated with higher viral complexity. An HBsAg mutation (L216*) was found to be more frequent in ALF patients and was associated with reduced HBsAg production and secretion. View Full-Text
Keywords: hepatitis B; HBV; reactivation; NGS; ALF; acute liver failure hepatitis B; HBV; reactivation; NGS; ALF; acute liver failure
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Anastasiou, O.E.; Theissen, M.; Verheyen, J.; Bleekmann, B.; Wedemeyer, H.; Widera, M.; Ciesek, S. Clinical and Virological Aspects of HBV Reactivation: A Focus on Acute Liver Failure. Viruses 2019, 11, 863.

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