An HIV-positive woman experienced a severe reactivation of hepatitis B virus (HBV) infection 2 months after lamivudine therapy was discontinued, according to a case report published in the September issue of The Journal of Infection. Dr. D. Neau, from Hopital Pellegrin, in Bordeaux, France, and colleagues describe a 38-year-old HIV-positive women who was referred to the hospital because of jaundice in October 1998.<\/p>\n
The patient was first diagnosed with HIV and chronic HBV infections in 1994. In October 1997, the patient had an increase in HIV-1 RNA levels and her current antiretroviral regimen was modified and stavudine and lamivudine were started. In July 1998, a new rise in HIV-1 RNA levels occurred and lamivudine was discontinued.<\/p>\n
At presentation, liver function tests “showed evidence of cytolysis and increased serum bilirubin.” Laboratory work-up ruled-out hepatitis A, C, E and eventually hepatitis delta virus. Using a branched-DNA hybridisation test, the patient’s serum was found to be strongly positive for HBV DNA.<\/p>\n
Further sequencing of the HBV precore region revealed a mutant strain. The patient’s condition improved within a few days and blood tests returned to normal in a matter of weeks. These findings are consistent with other similar case reports. In HIV-negative patients with chronic HBV infection, other investigators have noted elevations in ALT after discontinuation of lamivudine.<\/p>\n
In patients co-infected with HIV and HBV, the authors recommend monitoring liver function tests for several weeks after lamivudine is discontinued to detect a reactivation of HBV infection. If “antiretroviral therapy has to be modified, lamivudine should not be stopped, but should be continued at the dose of 100 mg\/day as used in isolated HBV infection,” Dr. Neau’s team concludes.<\/p>\n
Ref: J Infect 2000;41:192-194.<\/p>\n
Source: Reuters Health<\/p>\n","protected":false},"excerpt":{"rendered":"
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