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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| Published in | Internal Medicine Vol. 51; no. 12; pp. 1623 - 1626 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Japan
The Japanese Society of Internal Medicine
01.01.2012
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| Abstract | 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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| AbstractList | A 39-year-old man presented a CD4 T cell count of 78/ mu L and HIV-RNA at 6.6x105 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. 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. A 39-year-old man presented a CD4 T cell count of 78/µL and HIV-RNA at 6.6 × 10(5) 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. |
| Author | Kawano, Shinji Hoshina, Tokio Tamura, Kumi Nakazawa, Yasushi Sato, Fumiya Onodera, Shoichi Hori, Seiji Kato, Tetsuro Yoshida, Masaki Yoshikawa, Koji |
| Author_xml | – sequence: 1 fullname: Yoshida, Masaki organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 2 fullname: Hoshina, Tokio organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 3 fullname: Tamura, Kumi organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 4 fullname: Kawano, Shinji organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 5 fullname: Kato, Tetsuro organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 6 fullname: Sato, Fumiya organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 7 fullname: Nakazawa, Yasushi organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 8 fullname: Yoshikawa, Koji organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 9 fullname: Onodera, Shoichi organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan – sequence: 10 fullname: Hori, Seiji organization: Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan |
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| References | 15. Watanabe K, Takase K, Ohno S, Ideguchi H, Nozaki A, Ishigatsubo Y. Reactivation of hepatitis B virus in a hepatitis B surface antigen-negative patient with rheumatoid arthritis treated with methotrexate. Mod Rheumatol 2011 Sep 8 [Epub ahead of print]. 1. Lohse N, Hansen AB, Pedersen G, et al. Survival of persons with and without HIV infection in Denmark, 1995-2005. Ann Intern Med 146: 87-95, 2007. 17. French MA, Lenzo N, John M, et al. Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy. HIV Med 1: 107-115, 2000. 18. Shelburne SA, Visnegarwala F, Darcourt J, et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 19: 399-406, 2005. 10. Cicconi P, Cozzi-Lepri A, Phillips A, et al; ICoNA Study Group. Is the increased risk of liver enzyme elevation in patients co-infected with HIV and hepatitis virus greater in those taking antiretroviral therapy? AIDS 21: 599-606, 2007. 13. Koo YX, Tan DS, Tan IB, Tao M, Lim ST. Hepatitis B virus reactivation in a patient with resolved hepatitis B virus infection receiving maintenance rituximab for malignant B-cell lymphoma. Ann Intern Med 150: 655-656, 2009. 6. Koike K, Kikuchi Y, Kato M, et al. Prevalence of hepatitis B virus infection in Japanese patients with HIV. Hepatol Res 38: 310-314, 2008. 12. Núñez M, Soriano V. Management of patients co-infected with hepatitis B virus and HIV. Lancet Infect Dis 5: 374-382, 2005. 3. Ratnam I, Chiu C, Kandala NB, Easterbrook PJ. Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis 42: 418-427, 2006. 2. Murdoch DM, Venter WD, Van Rie A, Feldman C. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther 4: 9, 2007. 4. Thio CL, Seaberg EC, Skolasky R Jr, et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet 360: 1921-1926, 2002. 19. Lascar RM, Lopes AR, Gilson RJ, et al. Effect of HIV infection and antiretroviral therapy on hepatitis B virus (HBV)-specific T cell responses in patients who have resolved HBV infection. J Infect Dis 191: 1169-1179, 2005. 14. Papamichalis P, Alexiou A, Boulbou M, Dalekos GN, Rigopoulou EI. Reactivation of resolved hepatitis B virus infection after immunosuppression: is it time to adopt pre-emptive therapy? Clin Res Hepatol Gastroenterol 36: 84-93, 2011. 16. Kato M, Atsumi T, Kurita T, et al. Hepatitis B virus reactivation by immunosuppressive therapy in patients with autoimmune diseases: risk analysis in Hepatitis B surface antigen-negative cases. J Rheumatol 38: 2209-2214, 2011. 9. Kress KD. Antiretroviral-associated hepatotoxicity. Curr Infect Dis Rep 7: 103-107, 2005. 7. Filippini P, Coppola N, Pisapia R, et al. Impact of occult hepatitis B virus infection in HIV patients naive for antiretroviral therapy. AIDS 20: 1253-1260, 2006. 20. Crane M, Oliver B, Matthews G, et al. Immunopathogenesis of hepatic flare in HIV/hepatitis B virus (HBV)-coinfected individuals after the initiation of HBV-active antiretroviral therapy. J Infect Dis 199: 974-981, 2009. 11. Sulkowski MS, Thomas DL, Chaisson RE, Moore RD. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 283: 74-80, 2000. 8. den Brinker M, Wit FW, Wertheim-van Dillen PM, et al. Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection. AIDS 14: 2895-2902, 2000. 5. Kellerman SE, Hanson DL, McNaughten AD, Fleming PL. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects. J Infect Dis 188: 571-577, 2003. 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 |
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| Snippet | 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... A 39-year-old man presented a CD4 T cell count of 78/µL and HIV-RNA at 6.6 × 10(5) copies/mL at his first medical examination. After the 58th day, we initiated... A 39-year-old man presented a CD4 T cell count of 78/ mu L and HIV-RNA at 6.6x105 copies/mL at his first medical examination. After the 58th day, we initiated... |
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| SubjectTerms | 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 |
| Title | An HIV Patient with Hepatic Flare after the Initiation of HBV-active Antiretroviral Therapy |
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