title: Recurrence of another hepatitis B virus escape mutant comes back in a patient infected with HIV and low CD4+ count.
abstract: The case of an HIV-positive patient who cleared formerly acute HBV infection and experienced HBV exacerbation before starting antiretroviral therapy (ART) followed by a severe elevation of liver enzymes one month after the introduction of ART is reported. Laboratory tests revealed the presence of a subgenotype A2 carrying at least seven different mutations within the S protein and high lopinavir plasma concentrations. Irrespectively of the many possible mechanisms of HBV reactivation in patients infected with HIV (escape mutants selection, host immune deficiency progression, antiretroviral-related immune reconstitution, glucocorticosteroids, chemotherapy), the message is that HIV patients should be monitored strictly not only by serological and virological assays to recognize early HBV reactivation, but also for drug over-exposure.
authors.affiliation: III Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.forename: Erika
authors.initials: E
authors.lastname: Ebranati
authors.forename: Dario
authors.initials: D
authors.lastname: Cattaneo
authors.forename: Elena
authors.initials: E
authors.lastname: Gabanelli
authors.forename: Alessia
authors.initials: A
authors.lastname: Lai
authors.forename: Gianguglielmo
authors.initials: G
authors.lastname: Zehender
authors.forename: Cristina
authors.initials: C
authors.lastname: Gervasoni
mesh_terms: D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014775:Virus Activation
keywords: HBV reactivation; HIV infection; viral escape