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Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal.


J Hepatol. 1998 Aug;29(2):306-9. Unique Identifier : AIDSLINE

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.

JOURNAL ARTICLE Acquired Immunodeficiency Syndrome/*COMPLICATIONS/*DRUG THERAPY Anti-HIV Agents/*ADMINISTRATION & DOSAGE/THERAPEUTIC USE Case Report Drug Administration Schedule DNA, Viral/BLOOD Hepatitis B/COMPLICATIONS/*PHYSIOPATHOLOGY Hepatitis B Surface Antigens/*BLOOD Hepatitis B Virus/*GROWTH & DEVELOPMENT/ISOLATION & PURIF Homosexuality, Male Human Lamivudine/*ADMINISTRATION & DOSAGE/THERAPEUTIC USE Male Middle Age Recurrence *Virus Activation


Information in this article was accurate in January 30, 1999. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.