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HEPATITIS B IN HIV-INFECTED PATIENTS VACCINATED FOR HBV
PD James, N Ali, DK Wong
Department of Gastroenterology, Faculty of Medicine, University of Toronto, Toronto, Ontario
INTRODUCTION: HIV-infected persons have diminished response to HBV vaccination. Once HBV infection is established, HBV-HIV co-infected individuals are at risk for advanced disease and liver-related mortality. We report two unique cases of acute hepatitis B infection in HIV-infected persons who were previously vaccinated for HBV.
CASE 1: Male patient diagnosed with HIV in 2003 at 39 years of age. In 2004 he was anti-HBs negative despite three full courses of HBV vaccinations (one course before being HIV infected). In 2005, he experienced abdominal pain, nausea and vomiting shortly after being started on HAART (3TC-Tenfovir-Sustiva) with serum ALT 1,616. HIV therapy was stopped because of concern of drug-induced liver injury. Workup eventually demonstrated HBV serology positive for HBsAg, anti-HBe and IgM anti-HBc. His HBV DNA load in was less than 6 IU/mL when first checked.
CASE 2: Male patient diagnosed with HIV in 2004 at 24 years of age. He had previously been vaccinated for HBV in high school and was anti-HBs positive with a titre of 52 in 2004. In 2007, routine testing showed CD4 count 420 and serum ALT 207. His HBV serology revealed HBsAg and HBeAg positive, anti-HBs negative and HBV viral load 9.08 ×E9 IU/mL. He was started on HBV therapy with HIV coverage (3TC-Tenfovir-Kaletra) in an attempt to clear the acute HBV infection and prevent chronic HBV infection.
CONCLUSION: These cases highlight the importance hepatitis B in HIV-infected patients even if previously vaccinated for hepatitis B. To our knowledge, this is the first report of acute hepatitis B infection in an individual who demonstrated good immunological response to HBV vaccination.