Mixed cryoglobulinemia type II in chronic hepatitis B associated with HBe-minus HBV mutant: Cellular immune reactions and response to interferon treatment
✍ Scribed by Hanns Löhr; Bernd Goergen; Wolfgang Weber; Werner Godderz; Karl-Hermann Meyer zum Büschenfelde; Guido Gerken
- Publisher
- John Wiley and Sons
- Year
- 1994
- Tongue
- English
- Weight
- 737 KB
- Volume
- 44
- Category
- Article
- ISSN
- 0146-6615
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✦ Synopsis
Abstract
The case of a young female patient with chronic active hepatitis B, vasculitic purpura, edema, and circulating immune complexes due to mixed Cryoglobulinemia is described. Serum transami‐nases were elevated. Serological assays showed hepatitis B surface antigen (HBsAg), antibody to hepatitis B e antigen (anti‐HBe), and antibody to hepatitis B core antigen (anti‐HBc) antibodies but no antibody to hepatitis C virus (anti‐HCV) or antibody to hepatitis delta virus (anti‐HDV) antibodies. Using hepatitis B virus‐polymerase chain reaction (HBV‐PCR) and direct sequencing a precore/core (preC/C) mutant unable to synthesize HBeAg was detected in serum. HBV antigens were demonstrated in the circulating immune complexes. Following 1 month of treatment with interferon‐a 2b 3 miu three times weekly, alanine aminotransferases returned to normal levels while cryoglobulins and immune complexes disappeared from serum. In addition, 2 months after the onset of treatment serum HBV‐DNA was no longer detectable by PCR.
Prior to treatment the analysis of cellular immune reactions of peripheral blood mononu‐clear cells showed a major proliferative response to HBcAg, preS1Ag and HBxAg and a minor response to HBeAg and HBsAg. One month after conclusion of treatment a decline in T‐cell reactivity against all HBV antigens was observed. During clinical response to the therapy, however, a strong proliferative response of T cells to HBcAg and HBeAg was demonstrated.
In conclusion, immune complex disease may complicate chronic hepatitis B in patients expressing HBe‐minus HBV mutants. Treatment with interferon‐a was found to be effective in mixed Cryoglobulinemia even in the presence of HBe‐minus HBV mutants. Antiviral effects of interferon‐a induce a decrease in specific T‐cell recognition of HBV antigens. Clinical response and virus elimination were, however, accompanied by a reconstitution of cellular immune responses to HBV core antigens, i.e., HBcAg and HBeAg. The response to certain T cell epitopes on these antigens may be of pathogenetic relevance for virus elimination. © 1994 Wiley‐Liss, Inc.