Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal
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Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal. / Altfeld, M; Rockstroh, J K; Addo, Marylyn M.; Kupfer, B; Pult, I; Will, Hans; Spengler, U.
in: J HEPATOL, Jahrgang 29, Nr. 2, 08.1998, S. 306-9.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal
AU - Altfeld, M
AU - Rockstroh, J K
AU - Addo, Marylyn M.
AU - Kupfer, B
AU - Pult, I
AU - Will, Hans
AU - Spengler, U
PY - 1998/8
Y1 - 1998/8
N2 - BACKGROUND/AIMS: In HIV-infected patients, who have recovered completely from an acute hepatitis B infection and become anti-HBs positive, hepatitis B infection may be reactivated after progression to AIDS.CASE REPORT: We present the case of a homosexual male patient with AIDS who developed clinical and serological reactivation of hepatitis B with detectable HBV-DNA 18 years after complete recovery from acute hepatitis B infection. Prior to reactivation, antiretroviral triple therapy including lamivudine was changed to therapy without lamivudine. After reintroduction of lamivudine in the triple therapy, HBV-DNA became undetectable and the patient lost HBsAg and again developed anti-HBs antibodies.CONCLUSION: The hepatitis B in this patient can be explained best by reactivation of persistent HBV infection, possibly because of transient decline in antibodies against HBs-antigen due to a reduction in CD4+ lymphocyte numbers and B cell dysfunction. This observation points to the clinical relevance of HBV persistence in serum and blood cells of anti-HBs-positive subjects for many years after recovery from acute hepatitis B infection. The possible role of lamivudine withdrawal which immediately preceded HBV breakthrough in our patient is noteworthy. Regular monitoring of markers of HBV infection, including HBV-DNA, in patients with AIDS appears justified after discontinuation of lamivudine.
AB - BACKGROUND/AIMS: In HIV-infected patients, who have recovered completely from an acute hepatitis B infection and become anti-HBs positive, hepatitis B infection may be reactivated after progression to AIDS.CASE REPORT: We present the case of a homosexual male patient with AIDS who developed clinical and serological reactivation of hepatitis B with detectable HBV-DNA 18 years after complete recovery from acute hepatitis B infection. Prior to reactivation, antiretroviral triple therapy including lamivudine was changed to therapy without lamivudine. After reintroduction of lamivudine in the triple therapy, HBV-DNA became undetectable and the patient lost HBsAg and again developed anti-HBs antibodies.CONCLUSION: The hepatitis B in this patient can be explained best by reactivation of persistent HBV infection, possibly because of transient decline in antibodies against HBs-antigen due to a reduction in CD4+ lymphocyte numbers and B cell dysfunction. This observation points to the clinical relevance of HBV persistence in serum and blood cells of anti-HBs-positive subjects for many years after recovery from acute hepatitis B infection. The possible role of lamivudine withdrawal which immediately preceded HBV breakthrough in our patient is noteworthy. Regular monitoring of markers of HBV infection, including HBV-DNA, in patients with AIDS appears justified after discontinuation of lamivudine.
KW - Acquired Immunodeficiency Syndrome/complications
KW - Anti-HIV Agents/administration & dosage
KW - DNA, Viral/blood
KW - Drug Administration Schedule
KW - Hepatitis B/complications
KW - Hepatitis B Surface Antigens/blood
KW - Hepatitis B virus/growth & development
KW - Homosexuality, Male
KW - Humans
KW - Lamivudine/administration & dosage
KW - Male
KW - Middle Aged
KW - Recurrence
KW - Virus Activation
U2 - 10.1016/s0168-8278(98)80017-2
DO - 10.1016/s0168-8278(98)80017-2
M3 - SCORING: Journal article
C2 - 9722213
VL - 29
SP - 306
EP - 309
JO - J HEPATOL
JF - J HEPATOL
SN - 0168-8278
IS - 2
ER -