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Spontaneous Clearance of Hepatitis B Surface Antigenemia After Long-term Hemodialysis

Authors

  • Chinmay Patel,

    1. Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • Divya Monga,

    1. Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • Mohini Alexander,

    1. Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • Sandeep Magoon,

    1. Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • David Bernstein,

    1. Division of Hepatology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • John D. Wagner,

    1. Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, NSLIJ Health System, Great Neck, New York
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  • Joseph Mattana

    Corresponding author
    1. Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, New York
    • Address correspondence to: Joseph Mattana, M.D., Division of Nephrology and Hypertension, Winthrop University Hospital, 200 Old Country Road, Suite 135, Mineola, NY 11501, Tel.: 516-663-2169, Fax: 516-663-2179, or e-mail: jmattana@winthrop.org.

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  • Series Editor: Roger A. Rodby

Abstract

Persistent infection with the hepatitis B virus (HBV) [as indicated by chronic HBV surface antigenemia (HBsAg)] continues to be an important problem in end-stage renal disease (ESRD) patients and specifically in those receiving maintenance hemodialysis (HD). Patients on HD who are HBsAg-positive for a year have little chance of ever eliminating the virus; hence, clearance of HBsAg is a rare event in long-term HD patients. We report the case of a 62-year-old diabetic woman who was HBsAg-positive at the time she started HD and remained so until 10 years later when she became HBsAg-negative followed by the development of hepatitis B surface antibody (anti-HBs). Prior to her seroconversion, she suffered a persistent infection of her HD arteriovenous graft (AVG) that required prolonged antibiotics and several surgical procedures. We speculate that this immune stimulation contributed to her seroconversion.

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