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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 E

DOI: 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 workupBaseline before starting ART3 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 ARTReduction in HIV and HBV viral loads at 4 weeks ART initiationSeroconversion at 4 months of ART initiation
Liver chemistry
AST U/L286468482920
ALT U/L20109813704110
Total bilirubin mg/dL0.40.711.680.30.6
ALKP U/L591151316455
HIV viral load copies/mL168 57736
HBV viral load copies/mLNot detected295 304110 946
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.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923