Skip to main content

Advertisement

SpringerLink
Log in

Sustained elimination of hepatitis B virus from serum induced in a patient with chronic hepatitis B and advanced human immunodeficiency virus infection

  • Case Reports
  • Published:
The clinical investigator Aims and scope Submit manuscript

Abstract

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/μl. Discontinuation of prednisolone, previously prescribed by the patient's family practitioner because of elevated liver enzymes, resulted in severe hepatitis (alanine aminotransferase > 300U/1). Administration of interferon-α, (9 × 106U s.c. 3 × 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/μl, interferon-α 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abbreviations

HBV:

hepatitis B virus

HIV:

human immunodeficiency virus

IFN:

interferon

References

  1. Bain VG, Daniels HM, Chanas A, Alexander GJM, Williams R (1989) Foscarnet therapy in chronic hepatitis B virus E antigen carriers. J Med Virol 29: 152–155

    Google Scholar 

  2. Bodsworth NJ, Cooper DA, Donovan B (1991) The influence of human immunodeficiency virus type I on the development of the hepatitis B virus carrier state. J Infect Dis 163:1138–1140

    Google Scholar 

  3. Buller RM, Holmes KL, Hügin A, Frederickson TN, Morse III HC (1987) Induction of cytotoxic T-cell responses in vivo in the absence of CD4 helper cells. Nature 328: 77–79

    Google Scholar 

  4. Buti M, Esteban R, Esteban JI, Gonzalez A, Guardia J (1987) Severe hepatic failure after ARA-A-prednisolone for chronic type B hepatitis (letter). Gastroenterology 92: 274–275

    Google Scholar 

  5. Davis GL (1989) Interferon treatment of viral hepatitis in immunocompromised patients. Semin Liver Dis 9: 267–272

    Google Scholar 

  6. Degos F, Lugassy C, Degott C, Debure A, Carnot F, Theirs V, Tiollais P, Kreis H, Brechot C (1988) Hepatitis B virus and hepatitis B-related viral infection in renal transplant recipients. Gastroenterology 94: 151–156

    Google Scholar 

  7. Gilson RJ, Hawkins AE, Kelly GK, Gill SK, Weller IV (1991) No effect of zidovudine on hepatitis B virus in homosexual men with symptomatic HIV-1 infection. AIDS 5: 217–220

    Google Scholar 

  8. Gordon SC, Reddy KR, Gould EE, McFadden R, O'Brien C, De Medina M, Jeffers LJ, Schiff ER (1986) The spectrum of liver disease in the acquired immunodeficiency syndrome. J Hepatol 2: 475–484

    Google Scholar 

  9. Hadler SC, Judson FN, O'Malley PM, Altman NL, Penley K, Buchbinder S, Schable CA, Coleman PJ, Ostrow DN, Francis DP (1991) Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection. J Infect Dis 163: 454–459

    Google Scholar 

  10. Hess G, Manus M, Hütteroth T, Meyer zum Büschenfelde K-H (1987) Discontinuation of immunosuppressive therapy in hepatitis B surface antigen-positive chronic hepatitis: effect on viral replication and liver cell damage. Digestion 36: 47–54

    Google Scholar 

  11. Hess G, Rossol S, Voth R, Gerken G, Ramadori G, Drees N, Meyer zum Büschenfelde K-H (1989) Treatment of patients with chronic type hepatitis B and concurrent human immunodeficiency virus infection with a combination of interferon alpha and azidothymidine: a pilot study. Digestion 43: 56–59

    Google Scholar 

  12. Hoofnagle JH, Dusheiko GM, Schafer DF, Jones EA, Micetich KC, Young RC, Costa J (1982) Reactivation of chronic hepatitis B virus infection by cancer chemotherapy. Ann Intern Med 96: 447–449

    Google Scholar 

  13. Hoofnagle JH, Davis GL, Pappas SC, Hanson RG, Peters M, Avigan MI, Waggoner JG, Jones EA, Seeff LB (1986) A short course of prednisolone in chronic type B hepatitis: report of a randomized, double-blind, placebo-controlled trial. Ann Intern Med 104: 12–17

    Google Scholar 

  14. Housset C, Pol S, Carnot F, Dubois F, Nalpas B, Housset B, Berthelot P, Brechot C (1991) Interactions between human immunodeficiency virus-1, hepatitis delta virus and hepatitis B virus infections in 260 chronic carriers of hepatitis B virus. Hepatology 15: 578–583

    Google Scholar 

  15. Katkov WN, Dienstag JL (1991) Prevention and therapy of viral hepatitis. Semin Liver Dis 11: 165–174

    Google Scholar 

  16. Kingsley LA, Rinaldo CR, Lyter DW, Valdiserri RO, Belle SH, Ho M (1990) Sexual transmission efficiency of hepatitis B virus and human immunodeficiency virus among homosexual men. JAMA 264: 230–234

    Google Scholar 

  17. Koblin BA, Tylor PE, Rubinstein P, Stevens CE (1992) Effect of duration of hepatitis B virus infection on the association between human immunodeficiency virus type-1 and hepatitis B viral replication. Hepatology 15: 590–592

    Google Scholar 

  18. Krogsgaard K (1994) Does corticosteroid pretreatment enhance the effect of alfa interferon treatment in chronic hepatitis B? J Hepatol 20: 159–162

    Google Scholar 

  19. Lau JYN, Wright T (1993) Molecular virology and pathogenesis of hepatitis B. Lancet 342:1335–1340

    Google Scholar 

  20. Levy P, Marcellin P, Martinot-Peignoux M, Degott C, Nataf J, Benhamou JP (1990) Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B. Hepatology 12: 570–574

    Google Scholar 

  21. Liaw Y-F, Lin S-M, Chen T-J, Chien R-N, Sheen IS, Chu C-M, Chu C-M (1994) Beneficial effect of prednisolone withdrawal by human lymphoblastoid interferon on the treatment of chronic type B hepatitis in Asians: a randomized controlled trial. J Hepatol 20: 175–180

    Google Scholar 

  22. McNair ANB, Main J, Thomas HC (1992) Interactions of the human immunodeficiency virus and the hepatotropic viruses. Semin Liver Dis 12: 188–196

    Google Scholar 

  23. Mills TC, Lee E, Perillo R (1990) Relationship between histology, aminotransferase levels, and viral replication in chronic hepatitis B. Gastroenterology 99: 519–524

    Google Scholar 

  24. Nair PV, Tong MJ, Stevenson D, Roskamp D, Boone C (1986) A pilot study on the effects of prednisone withdrawal on serum hepatitis B virus DNA and HBeAg in chronic active hepatitis B. Hepatology 6: 1319–1324

    Google Scholar 

  25. Nayersina R, Fowler P, Guilhot S, Missale G, Cerny A, Schlicht H-J, Vitiello A., Chesnut R, Person JL, Redeker AG, Chisari FV (1993) HLA-A2 restricted cytotoxic T lymphocyte responses to multiple hepatitis B surface antigen epitopes during hepatitis B virus infection. J Immunol 150: 4659–4671

    Google Scholar 

  26. Novick DM, Farci P, Croxson TS, Taylor MB, Schneebaum VW, Lai ME, Bach N, Senie RT, Gelb, AM, Kreek MJ (1988) Hepatitis D virus and human immunodeficiency virus antibodies in parenteral drug abusers who are hepatitis B surface antigen positive. J Infect Dis 158: 795–803

    Google Scholar 

  27. Perrillo RP (1993) Antiviral therapy of chronic hepatitis B: past, present, and future. J Hepatol 17 [Suppl 3]: 56–63

    Google Scholar 

  28. Perillo RP, Regenstein FG, Roodman ST (1986) Chronic hepatitis B in asymptomatic homosexual men with antibody to human immunodeficiency virus. Ann Int Med 105: 382–383

    Google Scholar 

  29. Perillo RP, Regenstein FG, Peters MG, DeSchryver-Kecskemeti K, Bodicky CJ, Campbell CR, Kuhns MC (1988) Prednisone withdrawal followed by recombinant alpha interferon in the treatment of chronic type B hepatitis. A randomized, controlled trial. Ann Intern Med 109: 95–100

    Google Scholar 

  30. Perillo RP, Schiff ER, Davis GL, Bodenheimer HC, Lindsay K, Payne J, Dienstag JL, O'Brien C, Tamburro C, Jacobson IM, Sampliner R, Feit D, Lefkowitch J, Kuhns M, Meschievitz C, Sanghvi B, Albrecht J, Gibas A, the Hepatitis Interventional Therapy Group (1990) A randomized, controlled trial of interferon alpha-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B. N Engl J Med 321: 295–301

    Google Scholar 

  31. Peters M (1989) Mechanisms of action of interferons. Semin Liver Dis 9:235–239

    Google Scholar 

  32. Rieber EP, Rank G (1994) CDw60: a marker for human CD8+ helper cells. J Exp Med 179: 1385–1390

    Google Scholar 

  33. Scharschmidt BF, Held MJ, Hollander HH, Read AE, Lavine JE, Veereman G, McGuire RF, Thaler MM (1992) Hepatitis B in patients with HIV infection: relationship to AIDS and patient survival. Ann Intern Med 117: 837–838

    Google Scholar 

  34. Solomon RE, Van Raden M, Kaslow RA, Lyter D, Visscher B, Farzadegan H, Phair J (1990) Association of hepatitis surface and core antibody with acquisition and manifestations of human immunodeficiency virus type I infection. Am J Publ Health 80: 1475–1478

    Google Scholar 

  35. Vento S, Di Perri G, Luzzati R, Cruciani M, Garofano T, Mengoli C, Concia E, Bassetti D (1989) Clinical reactivation of hepatitis B in anti-HBs-positive patients with AIDS. Lancet I: 332–333

    Google Scholar 

  36. Visco G, Alba L, Grisetti S, Guarascio P, Narciso P, Sette P, Struglia C, Tossini G, Tozzi V (1993) Zidovudine plus interferon alpha-2b treatment in patients with HIV and chronic active viral hepatitis. Gut 34 [Suppl 2]: 107–1088

    Google Scholar 

  37. Waite J, Gilson RJC, Weller IV, Lacey CJ, Hambling MH, Hawkins A, Briggs M, Tedder RS (1988) Hepatitis B virus reactivation or reinfection associated with HIV-1 infection. AIDS 2: 443–448

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, Langenbeckstrasse 1, D-55131, Mainz, Germany

    T. Wölfe, J. Schlaak, P. Knollel, W. Dippold, K. -H. Meyer zum Büschenfelde & G. Gerken

  2. Institut für Pathologie, Johannes Gutenberg-Universität, Langenbeckstrasse 1, D-55131, Mainz, Germany

    P. Schirmacher & H. -P. Dienes

Authors
  1. T. Wölfe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Schirmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Schlaak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Knollel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. -P. Dienes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Dippold
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. -H. Meyer zum Büschenfelde
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Gerken
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Correspondence to: G. Gerken

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wölfe, T., Schirmacher, P., Schlaak, J. et al. Sustained elimination of hepatitis B virus from serum induced in a patient with chronic hepatitis B and advanced human immunodeficiency virus infection. Clin Investig 72, 1030–1036 (1994). https://doi.org/10.1007/BF00577750

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00577750

Key words

Search

Navigation