1/143. Highly active antiretroviral therapy used to treat concurrent hepatitis B and human immunodeficiency virus infections.We report a case of simultaneous infection with hepatitis b virus (HBV) and human immunodeficiency virus type 1 (hiv-1) in a 26-year-old Japanese homosexual man. He was admitted to our hospital for acute hepatitis caused by HBV. At that time, HIV-1antibody (Ab) was not detected in his serum. After 6 months, he was readmitted to our hospital for further examination of his liver because of confined liver enzyme abnormalities. Anti-HIV- Ab was detected in his serum by both enzyme immunosorbent assay (EIA) and particle agglutination (PA). His serum hiv-1 rna level was 50 x 10(4) copies/ml and serum levels of HBV dna polymerase (dna-P) and HBV dna were 6535cpm and 3 plus (>1000 copies/ml). His clinical course and laboratory data suggested progression from acute to chronic hepatitis related to coinfection with hiv-1. The diagnosis was chronic active hepatitis caused by HBV as an opportunistic infection due to coinfection with hiv-1. We began highly active antiretroviral therapy (HAART) because interferon (IFN) therapy was ineffective. HAART was started at an initial dosage of 600 mg zidovudine (AZT), 300 mg lamivudine (3TC), and 2400 mg indinavir (IDV) daily. After 4 weeks, the serum level of HBV dna-polymerase (p) had decreased markedly to 37cpm and that of hiv-1 rna had decreased to below the sensitivity threshold, indicating considerable suppression of the replication of these viruses by the treatment. But HBV dna remained at low levels. Although the incidence of HBV infection in patients with hiv-1 infection has been reported to be high in the united states and europe, simultaneous HBV and hiv-1 infection leading to persistent HBV infection is rare.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/143. Antiviral treatment for human immunodeficiency virus patients co-infected with hepatitis b virus: combined effect for both infections, an obtainable goal?A large percentage of human immunodeficiency virus (HIV) patients have serological evidence of a past or present hepatitis b virus infection (HBV). Long-term survival is increasing for HIV patients because of highly active antiretroviral therapy. Therefore, the chronic hepatitis B infection may become an important determinant of disease outcome in these co-infected patients. We describe two HIV/HBV co-infected patients who were treated with extended antiviral therapy, initially indicated for the HIV infection. lamivudine, a suppressor of viral replication in both infections, was one of these antiviral drugs. One patient showed a severe rebound of the HBV after withdrawal of lamivudine, the other patient developed a mutant hepatitis b virus after 18 months of treatment. This mutation was exclusively induced by lamivudine. These patients show that, with improved HIV-related survival, the HBV infection should be monitored carefully, thereby enabling the physician to interfere with therapy when necessary.- - - - - - - - - - ranking = 0.875keywords = hepatitis (Clic here for more details about this article) |
3/143. Management of liver failure in a haemophilic patient co-infected with human immunodeficiency and hepatitis c viruses.We present a case of liver failure in a haemophilic patient coinfected with transfusion acquired human immunodeficiency (HIV) and hepatitis c (HCV) viruses. The case illustrates the interaction of multiple viruses with accelerated progression to end stage liver disease and ultimately death. We report the impact on the patient management of two liver biopsies, which diagnosed an initial drug induced hepatitis and subsequently an atypical HCV related hepatitis.- - - - - - - - - - ranking = 0.875keywords = hepatitis (Clic here for more details about this article) |
4/143. Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine.lamivudine is a nucleoside analog with activity against human immunodeficiency virus (HIV) and hepatitis b virus (HBV). patients coinfected with HIV and HBV may have hepatitis flares when lamivudine therapy is discontinued or when resistance of HBV to lamivudine emerges. This retrospective, descriptive study conducted in three tertiary care medical centers describes patients coinfected with HIV type 1 and HBV who presented with a spectrum of clinical and subclinical hepatitic responses to lamivudine withdrawal or resistance. One patient had fulminant hepatic failure and a second patient had subclinical hepatitis when lamivudine therapy was discontinued and a more efficacious antiretroviral regimen was substituted. Three patients had flares of hepatitis after 13 to 18 months of lamivudine therapy. lamivudine withdrawal or emergence of lamivudine-resistant mutants in patients coinfected with HIV and HBV may result in severe hepatitis. Clinicians caring for patients with coinfection with HIV and HBV should be aware of the possibility that a hepatitis B flare may occur in previously asymptomatic carrier patients.- - - - - - - - - - ranking = 1.25keywords = hepatitis (Clic here for more details about this article) |
5/143. Post-transfusion HIV infection despite donor screening: a report of three cases.In August 1996, a blood donation was collected which subsequently infected three patients post-transfusion with HIV 1. The donation itself was originally screened as negative for anti-HIV 1/2 using a sensitive EIA method, but subsequently was shown to contain p24 Ag and HIV rna by an amplification technique. The proposed introduction of nucleic acid testing of all blood donations in the UK for hepatitis c, hepatitis B and HIV may further reduce the remote risk of further episodes of post-transfusion infection. The infection in the index recipient was detected on routine pre-transplant virological screening but proved difficult to confirm, at a time when she had recently received myeloablative treatment for a haematological malignancy which impaired the immune response. There is a need for continued vigilance in such patients to exclude post-transfusion infection, at a time when natural immunological responses have been impaired by their disease or treatment.- - - - - - - - - - ranking = 0.25keywords = hepatitis (Clic here for more details about this article) |
6/143. In vivo down regulation of HIV replication after hepatitis c superinfection.There are increasing molecular and clinical evidences that the effects of human immunodeficiency virus (HIV) infection can be modified by coinfection with other viruses. The objective was to investigate the viral interaction between HIV and hepatitis c virus (HCV) after HCV superinfection. A 16 year-old pregnant woman was evaluated because of icteric acute hepatitis. Admission laboratory tests showed the following results: ALT 877 IU/L; AST 1822 IU/L; bilirubin 6.79 mg/dl. diagnosis of acute HCV was based on detection of serum HCV rna by PCR and anti-HCV seroconversion. ELISA for anti HIV testing was positive and confirmed by western blot. serum markers for other viruses were negative. The patient was followed during 19 months; serum samples were taken monthly during this period for detection of plasma HIV and HCV rna. Levels of plasma HIV-rna were positive in all samples tested before and after the onset of acute hepatitis c. Six months later and a for two month period, and 13 months later for a period of one month HIV viremia was undetectable; then HIV-rna in plasma was detectable again. In conclusion, HCV superinfection may have temporarily interfered with HIV replication in our patient. The following observations support our hypothesis: it has been demonstrated that hiv-1 replication is suppressed by HCV core protein which has transcriptional regulation properties of several viral and cellular promoters. Clinical implications of this event are not generally known and the interaction between these two viruses in dual infections is worth considering.- - - - - - - - - - ranking = 0.875keywords = hepatitis (Clic here for more details about this article) |
7/143. The natural history of hepatitis c viral infection.Although early data suggested that chronic hepatitis c virus infection carried little risk, studies with longer duration of infection have reported concerning results. Of patients with acute infection, approximately 80% will develop chronic infection. The greatest risk of morbidity comes with cirrhosis and the resulting increased risk of hepatocellular carcinoma. The true risk of progression to cirrhosis, however, has emerged as an area of controversy. Both host and viral factors seem to impact susceptibility to chronic infection, cirrhosis, and hepatocellular carcinoma. hepatitis c virus has become the most common indication for liver transplantation, but the infection routinely recurs and may have a more aggressive course after transplantation. Given that current treatment options for hepatitis c virus infection are clearly not optimal, informed decisions regarding treatment require an in depth understanding of the natural history.- - - - - - - - - - ranking = 0.75keywords = hepatitis (Clic here for more details about this article) |
8/143. Late onset hepatitis and prolonged deterioration in hepatic function associated with nevirapine therapy.The aetiology of hepatic dysfunction in patients with HIV infection is multifactorial. Re-activation of hepatitis c infection, drug toxicity, and opportunistic infections are all potential causes. nevirapine (NVP) is a non-nucleoside reverse transcriptase inhibitor used as part of combination antiretroviral therapy for the treatment of HIV infection. It is associated with a significant incidence of hepatotoxicity, usually occurring in the initial month of therapy. We report the case of a 49-year-old man who developed NVP-induced prolonged hepatotoxicity 5 months after commencing antiretroviral therapy.- - - - - - - - - - ranking = 0.625keywords = hepatitis (Clic here for more details about this article) |
9/143. Persisting hiv-1 replication triggered by acute hepatitis a virus infection.We report the case of two patients in whom acute hepatitis A was associated with a marked and prolonged increase in human immunodeficiency virus type 1 (hiv-1) viral load. Although in one patient the rise in hiv-1 rna might also have been related to the interruption of antiretroviral therapy, we also observed a similar pattern in the other patient who had a stable undetectable plasma viraemia prior to acute hepatitis and never received treatment with anti-retrovirals. Our observation supports the hypothesis that immune activation that is induced by acute hepatitis a virus (HAV) infection may trigger hiv-1 replication. This highlights the importance of maintaining antiretroviral therapy throughout the acute phase of hepatitis A and of preventing HAV infection through active immunization.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
10/143. Interaction between nelfinavir and tacrolimus after orthoptic liver transplantation in a patient coinfected with HIV and hepatitis c virus (HCV).A 49-year old male patient with severe hemophilia a, coinfected with HIV and HCV, who underwent orthoptic liver transplantation because of hepatitis c cirrhosis is presented. We describe a strong interaction between nelfinavir and tacrolimus postoperatively, that caused a reduction of the dose of tacrolimus by a factor 70 compared with normal, to achieve therapeutic blood concentrations and to avoid toxic side effects. We suggest that nelfinavir inhibits the metabolism of tacrolimus because both compounds are well-known substrates for the cytochrome P450 isoenzyme CYP 3A4. The nelfinavir serum concentrations were not affected by the institution of tacrolimus. Although the interaction dramatically changed the tacrolimus dose-concentration relationship, the situation was manageable by frequent monitoring of blood concentrations of tacrolimus.- - - - - - - - - - ranking = 0.625keywords = hepatitis (Clic here for more details about this article) |
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