Reactivation of hepatitis B in patient with COVID-19

ABSTRACT

Objectives: Reactivation of hepatitis B is defined as dramatic increase in hepatitis B virus (HBV) replication in a patient with inactive or resolved hepatitis B. Reactivation can occur spontaneously but typically is triggered by immunosuppressive therapy or discontinuation of antiviral treatment. Some cases with COVID-19 progress into severe or critical disease requiring immunosuppressive therapy. Materials and Methods: We report the case of hepatitis B virus reactivation in a young adult with COVID-19. Results: 40-year-old male presented on day 7 of disease with sustaining fever and weakness. Chest CT scan revealed ground glass opacity. Nasopharyngeal mucus sample showed positive for SARSCov-2 PCR. Oxygen saturation (SpO2) was over 93% on room air. 10 years ago patient was diagnosed with HBV infection HBeAg +and high viral concentration, thus tenofovir was initiated. After 3 year of AVT seroconversion of HBeAg was achieved, after 5 years of AVT HBV PCR was negative. As treatment for COVID-19 high doses of methylprednisolone was administered and titrated during a month. Patient refused AVT, and it was terminated. COVID-19 resolved but after 2 months blood analysis revealed following ALT' 357 U/L, AST' 147 U/L, GGT' 110U/l, ALP' 67 U/L, PCR HBsAg' 11.000 U/L, HBeAg' positive, PCR HBV' positive. HBV reactivation was diagnosed and ATV was restarted. After 1 week of ATV HBsAg lowered to 9000, HBeAg became negative, ALT-1400 U/L, AST-375 U/L, GGT-191U/L, ALP-164U/L. 1 month later HBsAg was 76 U/L, HBeAg-negative and ALT-90 U/L, AST-46 U/L, GGT-116 U/L, ALP-72 U/L. After 2 months HBsAg became negative, without AntiHBsAg, ATV was continued. Conclusion: This case is a vivid example of the association of HBV reactivation and immunosuppressive treatment with discontinuation of AVT during COVID-19 and illustrates the importance of AVT maintenance and careful consideration of high doses of steroids in patients with HBV infection.