An HIV Patient with Hepatic Flare after the Initiation of HBV-active Antiretroviral Therapy

A 39-year-old man presented a CD4 T cell count of 78/μL and HIV-RNA at 6.6×105 copies/mL at his first medical examination. After the 58th day, we initiated HBV-active antiretroviral therapy. Three months after the start of antiretroviral therapy, he was diagnosed with hepatic flare on the basis of e...

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Bibliographic Details
Published inInternal Medicine Vol. 51; no. 12; pp. 1623 - 1626
Main Authors Yoshida, Masaki, Hoshina, Tokio, Tamura, Kumi, Kawano, Shinji, Kato, Tetsuro, Sato, Fumiya, Nakazawa, Yasushi, Yoshikawa, Koji, Onodera, Shoichi, Hori, Seiji
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 01.01.2012
Subjects
Adult
Alanine Transaminase - blood
Anti-HIV Agents - therapeutic use
antiretroviral therapy
Antiviral Agents - adverse effects
Aspartate Aminotransferases - blood
CD4 antigen
CD4 Lymphocyte Count
hepatic flare
Hepatitis B - complications
Hepatitis B - drug therapy
Hepatitis B - immunology
Hepatitis B - virology
Hepatitis B virus
Hepatitis B virus - genetics
Hepatitis B virus - isolation & purification
HIV Infections - complications
HIV Infections - immunology
HIV Infections - virology
Hospitals
Human immunodeficiency virus
human immunodeficiency virus (HIV)
Humans
Immune reconstitution
immune reconstitution inflammatory syndrome (IRIS)
Immune Reconstitution Inflammatory Syndrome - etiology
Immune Reconstitution Inflammatory Syndrome - immunology
Immune Reconstitution Inflammatory Syndrome - virology
Infection
Liver
Lymphocytes T
Male
resolved hepatitis B virus
RNA, Viral - blood
Viral Load
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Summary:A 39-year-old man presented a CD4 T cell count of 78/μL and HIV-RNA at 6.6×105 copies/mL at his first medical examination. After the 58th day, we initiated HBV-active antiretroviral therapy. Three months after the start of antiretroviral therapy, he was diagnosed with hepatic flare on the basis of elevated AST and ALT levels without detecting HBV-DNA. Although after continuing the medication his AST and ALT levels increased to 700 IU/L and 1,400 IU/L, respectively, he showed improvement following a natural course and was discharged from hospital after the 169th day. This is a case of hepatic flare likely caused by immune reconstitution associated with resolved HBV infection.
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ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.51.7244