16 April 2023: Articles
Acute Immune Reconstitution Inflammatory Syndrome-HBV Flare in an HIV/HBV Coinfected Patient After Antiretroviral Therapy Initiation: Case Report and Literature Review
Unknown etiology, Challenging differential diagnosis
Iqra Arshad A* , Mukti Gandhi E , Marcia Gossai E , Addi Feinstein EDOI: 10.12659/AJCR.939210
Am J Case Rep 2023; 24:e939210
Table 1. Timeline of development and resolution of acute immune reconstitution inflammatory syndrome-hepatitis B virus flare in a coinfected patient after antiretroviral therapy initiation.
| Laboratory workup | Baseline before starting ART | 3 Weeks after initiation of ART (on ED evaluation) | At hospital admission (3 weeks after ART started) | Normalization of liver enzymes on follow-up at 9 weeks of starting of ART | Reduction in HIV and HBV viral loads at 4 weeks ART initiation | Seroconversion at 4 months of ART initiation |
|---|---|---|---|---|---|---|
| Liver chemistry | ||||||
| AST U/L | 28 | 646 | 848 | 29 | 20 | |
| ALT U/L | 20 | 1098 | 1370 | 41 | 10 | |
| Total bilirubin mg/dL | 0.4 | 0.71 | 1.68 | 0.3 | 0.6 | |
| ALKP U/L | 59 | 115 | 131 | 64 | 55 | |
| HIV viral load copies/mL | 168 577 | 36 | ||||
| HBsAg | Reactive | Reactive | ||||
| HBV viral load copies/mL | Not detected | 295 304 | 110 946 | |||
| HBc-IgM | Non-reactive | Reactive | ||||
| HBeAg | Non-reactive | Reactive | Non-reactive | |||
| HBeAb | Reactive | |||||
| ART – antiretroviral therapy; AST – aspartate aminotransferase; ALT – alanine aminotransferase; ALKP – alkaline phosphatase; ED – Emergency Department; HBsAg – hepatitis B surface antigen; HBc-IgM – hepatitis B core IgM antibodies; HBeAg – hepatitis B e antigen; HBeAb – hepatitis B e antibodies. | ||||||