Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report
<p>Abstract</p> <p>Introduction</p> <p>There seem to be no published data concerning the clinical impact of populations of hepatitis B virus (HBV) in the hepatic and extrahepatic compartments of HIV-infected people with severe acute hepatitis.</p> <p>Case pr...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2009-11-01
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| Series: | Journal of Medical Case Reports |
| Online Access: | http://www.jmedicalcasereports.com/content/3/1/110 |
| _version_ | 1811298556825305088 |
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| author | Bagaglio Sabrina Albarello Luca Biswas Priscilla Uberti-Foppa Caterina Fortis Claudio Morsica Giulia |
| author_facet | Bagaglio Sabrina Albarello Luca Biswas Priscilla Uberti-Foppa Caterina Fortis Claudio Morsica Giulia |
| author_sort | Bagaglio Sabrina |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Introduction</p> <p>There seem to be no published data concerning the clinical impact of populations of hepatitis B virus (HBV) in the hepatic and extrahepatic compartments of HIV-infected people with severe acute hepatitis.</p> <p>Case presentation</p> <p>A 26-year-old Caucasian man presenting to our hospital with clinical symptoms suggesting acute hepatitis was found to have an acute hepatitis B profile upon admission. He developed fatal fulminant hepatitis and was found to be heavily immunocompromised due to HIV-1 infection. He had a high plasma HBV and HIV load, and analysis of the partial pre-S1/pre-S2 domain showed the presence of mixed infection with D and F genotypes. Analysis of the point mutations within this region revealed the presence of HBV strains with amino acid substitutions at the immunodominant epitopes involved in B or T cell recognition. A homogeneous population of a pre-core mutant strain harbouring the A1896G and A1899G affecting HBeAg expression was invariably found in the liver tissue, plasma and peripheral blood mononuclear cells despite active HBeAg secretion; it was the dominant strain in the liver only, and was characterised by the presence of two point mutations in the direct repeat 1 domain involved in HBV replication activity. Taken together, these mutations are indicative of a highly replicative virus capable of evading immune responses.</p> <p>Conclusion</p> <p>This case report provides clinical evidence of a possible association between the rapid spread of highly replicative escape mutants and the development of fulminant hepatitis in a heavily immunocompromised patient. Virological surveillance of severe acute hepatitis B may be important in establishing an early treatment strategy involving antiviral drugs capable of preventing liver failure, especially in individuals for whom liver transplantation is not accepted as a standard indication.</p> |
| first_indexed | 2024-04-13T06:21:06Z |
| format | Article |
| id | doaj.art-94b25f23e35240a6a84f3fc5ef33c891 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-13T06:21:06Z |
| publishDate | 2009-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-94b25f23e35240a6a84f3fc5ef33c8912022-12-22T02:58:38ZengBMCJournal of Medical Case Reports1752-19472009-11-013111010.1186/1752-1947-3-110Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case reportBagaglio SabrinaAlbarello LucaBiswas PriscillaUberti-Foppa CaterinaFortis ClaudioMorsica Giulia<p>Abstract</p> <p>Introduction</p> <p>There seem to be no published data concerning the clinical impact of populations of hepatitis B virus (HBV) in the hepatic and extrahepatic compartments of HIV-infected people with severe acute hepatitis.</p> <p>Case presentation</p> <p>A 26-year-old Caucasian man presenting to our hospital with clinical symptoms suggesting acute hepatitis was found to have an acute hepatitis B profile upon admission. He developed fatal fulminant hepatitis and was found to be heavily immunocompromised due to HIV-1 infection. He had a high plasma HBV and HIV load, and analysis of the partial pre-S1/pre-S2 domain showed the presence of mixed infection with D and F genotypes. Analysis of the point mutations within this region revealed the presence of HBV strains with amino acid substitutions at the immunodominant epitopes involved in B or T cell recognition. A homogeneous population of a pre-core mutant strain harbouring the A1896G and A1899G affecting HBeAg expression was invariably found in the liver tissue, plasma and peripheral blood mononuclear cells despite active HBeAg secretion; it was the dominant strain in the liver only, and was characterised by the presence of two point mutations in the direct repeat 1 domain involved in HBV replication activity. Taken together, these mutations are indicative of a highly replicative virus capable of evading immune responses.</p> <p>Conclusion</p> <p>This case report provides clinical evidence of a possible association between the rapid spread of highly replicative escape mutants and the development of fulminant hepatitis in a heavily immunocompromised patient. Virological surveillance of severe acute hepatitis B may be important in establishing an early treatment strategy involving antiviral drugs capable of preventing liver failure, especially in individuals for whom liver transplantation is not accepted as a standard indication.</p>http://www.jmedicalcasereports.com/content/3/1/110 |
| spellingShingle | Bagaglio Sabrina Albarello Luca Biswas Priscilla Uberti-Foppa Caterina Fortis Claudio Morsica Giulia Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report Journal of Medical Case Reports |
| title | Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report |
| title_full | Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report |
| title_fullStr | Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report |
| title_full_unstemmed | Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report |
| title_short | Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report |
| title_sort | virological pattern of hepatitis b infection in an hiv positive man with fatal fulminant hepatitis b a case report |
| url | http://www.jmedicalcasereports.com/content/3/1/110 |
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