Case Report
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World J Gastroenterol. Aug 28, 2010; 16(32): 4107-4111
Published online Aug 28, 2010. doi: 10.3748/wjg.v16.i32.4107
Development of fatal acute liver failure in HIV-HBV coinfected patients
Albert M Anderson, Marina B Mosunjac, Melody P Palmore, Melissa K Osborn, Andrew J Muir
Albert M Anderson, Marina B Mosunjac, Melody P Palmore, Melissa K Osborn, Emory University School of Medicine, Grady Health System Infectious Diseases Program, 341 Ponce de Leon Avenue, Atlanta, GA 30308, United States
Andrew J Muir, Duke University School of Medicine, DUMC 3913, Durham, North Carolina, CA 27710, United States
Author contributions: Anderson AM, Mosunjac MB, Palmore MP and Osborn MK performed the research; Mosunjac MB performed pathological analysis; Anderson AM and Muir AJ analyzed the research and wrote the paper.
Correspondence to: Albert M Anderson, MD, MHS, Emory University School of Medicine, Grady Health System Infectious Diseases Program, 341 Ponce de Leon Avenue, Atlanta, Georgia, GA 30308, United States. aande2@emory.edu
Telephone: +1-404-6166864 Fax: +1-404-6169732
Received: April 1, 2010
Revised: May 31, 2010
Accepted: June 7, 2010
Published online: August 28, 2010
Abstract

Coinfection with hepatitis B virus (HBV) is not uncommon in human immunodeficiency virus (HIV)-infected individuals and patients with HIV-HBV coinfection are at high risk for progression of liver disease. Current guidelines regarding the treatment of HIV infection recommend that patients who are coinfected with HIV and HBV receive highly active antiretroviral therapy (HAART) with activity against hepatitis B. While HIV-HBV coinfected patients often experience liver enzyme elevations after starting antiretroviral therapy, acute liver failure (ALF) is rare and typically occurs with older antiretroviral agents with known potential for hepatotoxicity. We describe two cases of fatal ALF in the setting of HIV-HBV coinfection after initiation of HAART. These cases occurred despite treatment with antiretrovirals that have activity against HBV and highlight the challenges in distinguishing drug hepatotoxicity and HBV immune reconstitution inflammatory syndrome. HIV-HBV coinfected patients should be monitored closely when initiating HAART, even when treatment includes agents that have activity against HBV.

Keywords: Hepatitis B virus; Human immunodeficiency virus; Liver failure