2019, Number 1
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Ann Hepatol 2019; 18 (1)
Immune Reconstitution Syndrome with Initiation of Treatment of HBV/HIV Co-infection: Activity Flare associated with E antigen Seroconversion
Rowley MW, Patel A, Zhou W, Wong M, Seetharam AB
Language: English
References: 19
Page: 220-224
PDF size: 214.25 Kb.
ABSTRACT
Immune reconstitution syndrome is a recognized complication with initiation of highly active antiretroviral therapy for acquired immune
deficiency syndrome patients co-infected with hepatitis B. Hepatitis B flares are seen in 20%-25% of patients after initiation of
highly active antiretroviral therapy, an estimated 1%-5% of whom develop clinical hepatitis. We present a case of highly active
antiretroviral therapy initiation for HIV that led to a flare of HBV activity despite antiviral therapy directed towards both. Liver biopsy
and longitudinal serologic evaluation lend support to the hypothesis that the flare in activity was representative of IRIS. Importantly,
we document eAg/eAb seroconversion with the IRIS phenomenon.
REFERENCES
Schweitzer A, Horn J, Mikolajczk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 2015; 386: 1546-55.
National health and nutrition examination survey. 2008
Soriano V, Puoti M, Peters M, Benhamou Y, Sulkowski M, Zoulim F, Mauss S, et al. Care of HIV patients with chronic hepatitis B: updated recommendations from the HIV-Hepatitis B Virus International Panel. AIDS 2008; 22: 1399-410.
Hadler SC, Judson FN, O’Malley PM, Altman NL, Penley K, Buchbinder S, Schable CA, et al. Outcome of hepatitis B virus infection in homosexual men and its relation to prior immunodeficiency virus infection. J Infect Dis 1991; 163: 454-9.
Bodsworth NJ, Cooper DA, Donovan B. The influence of human immunodeficiency virus type 1 infection on the development of the HBV carrier state. J Infect Dis 1991; 163: 1138-40.
Soriano V, Poveda E, Vispo E, Barreiro P. Hepatitis B in HIVinfected patients. Clin Liver Dis 2013; 17: 489-501.
Iloeje U, Yang H, Su J, Jen CL, You SL, Chen CJ. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology 2006; 130: 678-86.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the centers for disease control and prevention, the national institutes of health, and the HIV medicine association of the infectious diseases society of America. Available at http://aidsinfo.nih.gov/contentfiles/ Ivguidelines/adult oi.pdf . Accessed Jan 2017.
Avihingsanon A, Matthews GV, Lewin SR, Marks P, Sasadeusz J, Cooper DA, Bowden S, et al. Assessment of HBV flare in a randomized clinical trial in HIV/HBV coinfected subjects initiating HBV-active antiretroviral therapy in Thailand. AIDS Res Ther 2012; 9: 6.
French M. HIV/AIDS: immune reconstitution inflammatory syndrome: a reappraisal. Clin Infect Dis 2009; 48: 101-7.
Haddow LJ, Easterbrook PJ, Mosam A, Khanyile NG, Parboosing R, Moodley P, Moosa MY. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis 2009; 29: 1424-32.
Milich D, Liang TJ. Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection. Hepatology 2003; 38: 1075-86.
Crane M, Oliver B, Matthews G, Avihingsanon A, Ubolyam S, Markovska V, Chang JJ, et al. Immunopathogenesis of hepatitis flare in HIV/HBV coinfected individuals after initiation of HBV-active antiretroviral therapy. J Infect Dis 2009; 199: 974-81.
Moroti R, Munteanu D, Radulescu M, Hristea A, Niculescu I, Mihailescu R, Petre R, et al. Toxoplasmosis: a rare cause of IRIS in HIV infected patients. case series. BMC Infect Dis 2013; 13: 07.
Saha D, Pal A, Biswas A, Panigrahi R, Sarkar N. Molecular characterization of HBV strains circulating among the treatment- naïve HIV/HBV co-infected patients of eastern India. PLos ONE 2014; 9(2): e90432.doi:10.1371/journal.pone. 0090432.
Mitsumoto F, Murata M, Kato Y, Ura K, Takayama K, Haramine S, Ikezaki H, et al. Hepatitis B virus-related immune reconstitution inflammatory syndrome in two patients coinfected with human immunodeficiency virus diagnosed with a liver biopsy. Intern Med 2014; 53: 2165-70.
Wit FW, Weverling GJ, Weel J, Jurriaans S, Lange JM. Incidence of and risk factors for severe hepatotoxicity associated with antiretroviral combination therapy. J Infect Dis 2002; 186: 23-31.
Anderson AM, Mosunjac MB, Palmore MP, Osborn MK, Muir AJ. Development of fatal acute liver failure in HIV-HBV coinfected patients. World J of Gastroenterol 2010; 16: 4107-11.
Mitsumoto F, Murata M, Ura K, Takayama K, Hiramine S, Shimizu M, Toyoda K, et al. The kinetics of the HBsAg levels after the initiation of antiretroviral therapy for HBV and HIV coinfected patients. J of Infect Chemother 2015; 21: 264-71.