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

Masaki Yoshida; Tokio Hoshina; Kumi Tamura; Shinji Kawano; Tetsuro Kato; Fumiya Sato; Yasushi Nakazawa; Koji Yoshikawa; Shoichi Onodera; Seiji Hori

doi:10.2169/internalmedicine.51.7244

CASE REPORTS

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

Masaki Yoshida, Tokio Hoshina, Kumi Tamura, Shinji Kawano, Tetsuro Kato, Fumiya Sato, Yasushi Nakazawa, Koji Yoshikawa, Shoichi Onodera, Seiji Hori

Author information

Masaki Yoshida
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Tokio Hoshina
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Kumi Tamura
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Shinji Kawano
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Tetsuro Kato
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Fumiya Sato
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Yasushi Nakazawa
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Koji Yoshikawa
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Shoichi Onodera
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan
Seiji Hori
Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Japan

Keywords: human immunodeficiency virus (HIV), resolved hepatitis B virus, immune reconstitution inflammatory syndrome (IRIS), hepatic flare

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 12 Pages 1623-1626

DOI https://doi.org/10.2169/internalmedicine.51.7244

Details

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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