title: Probable corticosteroid-induced reactivation of latent hepatitis B virus infection in an HIV-positive patient involving immune escape.
abstract: We describe a patient infected with human immunodeficiency virus who possessed a serological profile suggesting a previous cleared acute hepatitis B virus (HBV) infection, including high levels of antibodies against HBV surface antigen (anti-HBs). Following the administration of inhaled glucocorticosteroids combined with protease inhibitor-based antiretroviral treatment, the patient developed an unexpected severe acute hepatitis despite persistence of anti-HBs. A genotype A2 strain emerged with 2 major mutations in the S gene, sK122R and sD144E. Molecular and biological analyses strongly suggested reactivation of a latent HBV infection. The importance and the molecular basis of these 2 epitopes in immune-escape mechanisms and host-virus interactions are discussed.
authors.affiliation: Centre de Recherche en Cancérologie de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
authors.forename: Nora
authors.initials: N
authors.lastname: Martel
authors.forename: Laurent
authors.initials: L
authors.lastname: Cotte
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Trabaud
authors.forename: Christian
authors.initials: C
authors.lastname: Trepo
authors.forename: Fabien
authors.initials: F
authors.lastname: Zoulim
authors.forename: Selma A
authors.initials: SA
authors.lastname: Gomes
authors.forename: Alan
authors.initials: A
authors.lastname: Kay
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D019943:Amino Acid Substitution; D019380:Anti-HIV Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000939:Epitopes / Q000235:genetics / Q000276:immunology; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D057131:Immune Evasion; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents; D000939:Epitopes; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents