PMID- 37061778
OWN - NLM
STAT- MEDLINE
DCOM- 20230418
LR  - 20230424
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 24
DP  - 2023 Apr 16
TI  - Acute Immune Reconstitution Inflammatory Syndrome-HBV Flare in an HIV/HBV 
      Coinfected Patient After Antiretroviral Therapy Initiation: Case Report and 
      Literature Review.
PG  - e939210
LID - 10.12659/AJCR.939210 [doi]
AB  - BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) is a 
      well-recognized complication after antiretroviral therapy (ART) initiation among 
      patients with HIV. Acute HBV flares after starting antiretroviral therapy have 
      been reported in 20% to 25% of coinfected patients, among whom only 1% to 5% 
      develop clinical hepatitis. Liver biopsy and serological evaluation help in 
      diagnosis. CASE REPORT A 24-year-old man with history of HIV diagnosed in 2018 
      developed severe IRIS-related HBV flare after initiation of ART. He was taking 
      ART since 2018 until his immigration to the United States in 2021. He came to 
      establish care and was started on bictegravir/emtricitabine/tenofovir alafenamide 
      (BIC/F/TAF). Three weeks later, he presented to the Emergency Department with 
      polyarthralgia and loose stools; transaminases showed an increasing trend on 
      follow-up. He was admitted for closer monitoring. Workup was remarkable for 
      reactive HBsAg, HBeAg, and HBcIgM antibodies, with HBV viral load of 295 304 
      copies/mL. Abdominal imaging was unremarkable. ART was switched to 
      rilpivirine/emtricitabine/tenofovir alafenamide (RPV/FTC/TAF), considering the 
      hypothetical risk of hepatotoxicity from BIC/F/TAF. Despite therapy, 
      transaminases were up-trending. He underwent computerized tomography-guided liver 
      biopsy, showing moderate to severe acute hepatitis, compatible with IRIS. He 
      received steroids, and ART was continued. Transaminases resolved, HBV load 
      reduced significantly, HIV load became undetectable at 9 weeks, and he developed 
      HBeAb (seroconversion) at 4 months after initiating ART. CONCLUSIONS Our case 
      highlights the importance of early recognition and management of IRIS-HBV flares 
      after initiation of ART among coinfected patients. Liver biopsy is indicated for 
      definitive diagnosis. ART directed against both viruses should be continued.
FAU - Arshad, Iqra
AU  - Arshad I
AD  - Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA.
FAU - Gandhi, Mukti
AU  - Gandhi M
AD  - Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA.
FAU - Gossai, Marcia
AU  - Gossai M
AD  - Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA.
FAU - Feinstein, Addi
AU  - Feinstein A
AD  - Division of Infectious Diseases, Lincoln Medical Center, Bronx, NY, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20230416
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - EL9943AG5J (tenofovir alafenamide)
RN  - G70B4ETF4S (Emtricitabine)
RN  - EC 2.6.1.- (Transaminases)
SB  - IM
MH  - Male
MH  - Humans
MH  - Young Adult
MH  - Adult
MH  - *HIV Infections/complications/drug therapy
MH  - Hepatitis B virus
MH  - *Coinfection
MH  - *Immune Reconstitution Inflammatory Syndrome/chemically induced/complications
MH  - Emtricitabine/therapeutic use
MH  - Transaminases/therapeutic use
PMC - PMC10119969
COIS- Conflict of interest: None declared
EDAT- 2023/04/17 06:00
MHDA- 2023/04/18 06:41
PMCR- 2023/04/16
CRDT- 2023/04/16 01:22
PHST- 2023/04/18 06:41 [medline]
PHST- 2023/04/16 01:22 [entrez]
PHST- 2023/04/17 06:00 [pubmed]
PHST- 2023/04/16 00:00 [pmc-release]
AID - 939210 [pii]
AID - 10.12659/AJCR.939210 [doi]
PST - epublish
SO  - Am J Case Rep. 2023 Apr 16;24:e939210. doi: 10.12659/AJCR.939210.