Hepatitis B virus surface antigen and e antigen seroconversion in a known HBSS adolescent – Case report and review of the literature on treatment options and outcome

Abstract

Hepatitis B virus (HBV) infection remains a global public health challenge with an estimated 257 million people in 2015 living as chronic carriers. Sub-Saharan Africa has the second largest global burden of these chronic carriers of HBV infection. Children with sickle cell anemia (HBSS) are prone to recurrent blood transfusion with the attendant risk of blood-borne diseases including hepatitis B infection. There are several studies in Nigeria on the prevalence of viral hepatitis B infection in children with sickle cell anemia. However, there is no report on the treatment of children with HBSS infected with HBV. This case describes a 16-year-old known HBSS female adolescent who presented with acute derangement of liver function test, marked jaundice, and positive viral hepatitis B serology. Her HBV DNA was remarkably high at 4,880,000 IU/ml and monotherapy on tenofovir, a nucleoside analog led to a return of liver enzymes to normal values at 3 months into treatment, seroconversion of hepatitis B surface antigen (HBsAg) to anti-HBs and hepatitis B e-antigen (HBeAg) to anti-HBe at 12 months into treatment, and 24 months into treatment, the patient maintained sustained virological response (undetectable HBV-DNA). Over 3 years into treatment, she has maintained functional cure, virological response, and biochemical response to treatment. Nucleoside analog is effective in the treatment of viral hepatitis B infection in HBSS adolescents.