Sustained elimination of hepatitis B virus from serum induced in a patient with chronic hepatitis B and advanced human immunodeficiency virus infection.
A 48-year-old male patient was admitted with acquired immunodeficiency syndrome (stage III, Centers for Disease Control 1993) and viremic hepatitis B. Blood CD4 count was 15/microliters. Discontinuation of prednisolone, previously prescribed by the patient's family practitioner because of elevated liver enzymes, resulted in severe hepatitis (alanine aminotransferase > 300U/l). Administration of interferon-alpha (9 x 10(6) U s.c. 3 x weekly) was initiated. Serum markers of viral replication disappeared, and aminotransferase levels returned to normal within a few weeks. The patient's serum was found negative for HBsAg after 3 months. Immunohistochemical analysis of liver biopsies before and during interferon therapy showed disappearance of all hepatitis B virus antigens and a marked reduction in inflammatory activity. Hepatitis B virus seroconversion remained stable until the patient died from the syndrome 2 years later. This case shows that in spite of severe HIV-associated immune deficiency with CD4 counts constantly below 100/microliters, interferon-alpha can lead to sustained serological and histological improvement of viremic hepatitis B. Previous administration and discontinuation of cortisone may have helped to reach this effect.
Wölfel
T
T
I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, Mainz, Germany.
Schirmacher
P
P
Schlaak
J
J
Knolle
P
P
Dienes
H P
HP
Dippold
W
W
Meyer zum Büschenfelde
K H
KH
Gerken
G
G
D017088:AIDS-Related Opportunistic Infections / Q000628:therapy*; D002908:Chronic Disease; D006509:Hepatitis B / Q000628:therapy*; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014766:Viremia / Q000628:therapy*
D016898:Interferon-alpha