Acute Hepatitis C in an HIV-Infected patient: A Case Report and Review of Literature
Clinical Practice: Clinical Vignettes
First Online: 14 November 2012 Received: 31 May 2011 Revised: 18 September 2012 Accepted: 10 October 2012 DOI:
Cite this article as: Driver, T.H., Terrault, N. & Saxena, V. J GEN INTERN MED (2013) 28: 734. doi:10.1007/s11606-012-2258-3 ABSTRACT
With the decrease in transmission via transfusions and injection drug use, acute symptomatic hepatitis C is infrequently seen in developed countries. We report a case of a human immunodeficiency virus (HIV)–infected adult who presented with abdominal pain. His alanine aminotransferase was greater than sixty times the upper limit of normal without any evidence on examination of fulminant hepatic failure. His workup revealed an elevated hepatitis C viral level with a negative hepatitis C antibody. He was discharged once his liver function tests improved. As an outpatient, he had a recurrent bout of symptoms with an elevation of his alanine aminotransferase and hepatitis C viral levels that promoted anti-hepatitis C virus treatment. This case illustrates the importance of considering acute hepatitis C as a cause of acute hepatitis in HIV-infected men who have sex with men. While patients with acute symptomatic hepatitis C generally have a higher rate of spontaneous viral clearance compared to those with an insidious acute infection, most still progress to chronic hepatitis C infection, and patients with HIV coinfection carry a higher risk of progression to chronic disease.
KEY WORDS acute hepatitis C virus human immunodeficiency virus hepatitis C virus treatment REFERENCES
Maheshwari A, Ray S, Thuluvath PJ.
Acute hepatitis C. Lancet. 2008;372:321–32.
Orland JR, Wright TL, Cooper S.
Acute hepatitis C. Hepatology. 2001;33:321–7.
Serpaggi J, Chaix ML, Batisse D, et al.
Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1-infected men and inefficacy of early antiviral therapy. AIDS. 2006;20:233–40.
Rauch A, Rickenbach M, Weber R, et al.
Unsafe sex and increased incidence of hepatitis C virus infection among HIV-infected men who have sex with men: the Swiss HIV Cohort Study. Clin Infect Dis. 2005;41:395–402.
Fox J, Nastouli E, Thomson E, et al.
Increasing incidence of acute hepatitis C in individuals diagnosed with primary HIV in the United Kingdom. AIDS. 2008;22:666–8.
Richardson D, Fisher M, Sabin CA.
Sexual transmission of hepatitis C in MSM may not be confined to those with HIV infection. J Infect Dis. 2008;197:1213–4. author reply 4–5.
Buffington J, Murray PJ, Schlanger K, et al.
Low prevalence of hepatitis C virus antibody in men who have sex with men who do not inject drugs. Public Health Rep. 2007;122(Suppl 2):63–7.
Danta M, Brown D, Bhagani S, et al.
Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS. 2007;21:983–91.
Dougan S, Evans BG, Elford J.
Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis. 2007;34:783–90.
Matthews GV, Hellard M, Kaldor J, Lloyd A, Dore GJ.
Further evidence of HCV sexual transmission among HIV-positive men who have sex with men: response to Danta et al. AIDS. 2007;21:2112–3.
van de Laar TJ, van der Bij AK, Prins M, et al.
Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196:230–8.
Wang CC, Krantz E, Klarquist J, et al.
Acute hepatitis C in a contemporary US cohort: modes of acquisition and factors influencing viral clearance. J Infect Dis. 2007;196:1474–82.
Santantonio T, Medda E, Ferrari C, et al.
Risk factors and outcome among a large patient cohort with community-acquired acute hepatitis C in Italy. Clin Infect Dis. 2006;43:1154–9.
Turner JM, Rider AT, Imrie J, et al.
Behavioural predictors of subsequent hepatitis C diagnosis in a UK clinic sample of HIV positive men who have sex with men. Sex Transm Infect. 2006;82:298–300.
Alary M, Joly JR, Vincelette J, Lavoie R, Turmel B, Remis RS.
Lack of evidence of sexual transmission of hepatitis C virus in a prospective cohort study of men who have sex with men. Am J Public Health. 2005;95:502–5.
Gambotti L, Batisse D, Colin-de-Verdiere N, et al.
Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001–2004. Euro Surveill. 2005;10:115–7.
Gotz HM, van Doornum G, Niesters HG, den Hollander JG, Thio HB, de Zwart O.
A cluster of acute hepatitis C virus infection among men who have sex with men–results from contact tracing and public health implications. AIDS. 2005;19:969–74.
Amin J, Kaye M, Skidmore S, Pillay D, Cooper DA, Dore GJ.
HIV and hepatitis C coinfection within the CAESAR study. HIV Med. 2004;5:174–9.
Browne R, Asboe D, Gilleece Y, et al.
Increased numbers of acute hepatitis C infections in HIV positive homosexual men; is sexual transmission feeding the increase? Sex Transm Infect. 2004;80:326–7.
Ghosn J, Pierre-Francois S, Thibault V, et al.
Acute hepatitis C in HIV-infected men who have sex with men. HIV Med. 2004;5:303–6.
Diamond C, Thiede H, Perdue T, et al.
Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis. 2003;30:425–32.
Sexual transmission of hepatitis C and early intervention. J Assoc Nurses AIDS Care. 2003;14:87S–94S.
Hammer GP, Kellogg TA, McFarland WC, et al.
Low incidence and prevalence of hepatitis C virus infection among sexually active non-intravenous drug-using adults, San Francisco, 1997–2000. Sex Transm Dis. 2003;30:919–24.
Marx MA, Murugavel KG, Tarwater PM, et al.
Association of hepatitis C virus infection with sexual exposure in southern India. Clin Infect Dis. 2003;37:514–20.
Saxton PJ, Hughes AJ, Robinson EM.
Sexually transmitted diseases and hepatitis in a national sample of men who have sex with men in New Zealand. N Z Med J. 2002;115:U106.
Filippini P, Coppola N, Scolastico C, et al.
Does HIV infection favor the sexual transmission of hepatitis C? Sex Transm Dis. 2001;28:725–9.
Matthews GV, Hellard M, Haber P, et al.
Characteristics and treatment outcomes among HIV-infected individuals in the Australian Trial in Acute Hepatitis C. Clin Infect Dis. 2009;48:650–8.
Clinical syndromes and consequences of antiretroviral-related hepatotoxicity. Hepatology. 2010;52:1143–55.
Anderson KB, Guest JL, Rimland D.
Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: data from the HIV Atlanta VA Cohort Study. Clin Infect Dis. 2004;39:1507–13.
Vogel M, Deterding K, Wiegand J, et al.
Initial presentation of acute hepatitis C virus (HCV) infection among HIV-negative and HIV-positive individuals-experience from 2 large German networks on the study of acute HCV infection. Clin Infect Dis. 2009;49:317–9. author reply 9.
Romanowski B, Preiksaitis J, Campbell P, Fenton J.
Hepatitis C seroprevalence and risk behaviors in patients attending sexually transmitted disease clinics. Sex Transm Dis. 2003;30:33–8.
Vandelli C, Renzo F, Romano L, et al.
Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol. 2004;99:855–9.
Boesecke C, Vogel M.
HIV and hepatitis C co-infection: acute HCV therapy. Curr Opin HIV AIDS. 2011;6:459–64.
Matthews-Greer JM, Caldito GC, Adley SD, et al.
Comparison of hepatitis C viral loads in patients with or without human immunodeficiency virus. Clin Diagn Lab Immunol. 2001;8:690–4.
Bowen DG, Walker CM.
Adaptive immune responses in acute and chronic hepatitis C virus infection. Nature. 2005;436:946–52.
Dustin LB, Rice CM.
Flying under the radar: the immunobiology of hepatitis C. Annu Rev Immunol. 2007;25:71–99.
Gruner NH, Gerlach TJ, Jung MC, et al.
Association of hepatitis C virus-specific CD8+ T cells with viral clearance in acute hepatitis C. J Infect Dis. 2000;181:1528–36.
Danta M, Semmo N, Fabris P, et al.
Impact of HIV on host-virus interactions during early hepatitis C virus infection. J Infect Dis. 2008;197:1558–66.
Kim AY, Schulze zur Wiesch J, Kuntzen T, et al.
Impaired hepatitis C virus-specific T cell responses and recurrent hepatitis C virus in HIV coinfection. PLoS Med. 2006;3:e492.
Micallef JM, Kaldor JM, Dore GJ.
Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. 2006;13:34–41.
Gerlach JT, Diepolder HM, Zachoval R, et al.
Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology. 2003;125:80–8.
Thomas DL, Astemborski J, Rai RM, et al.
The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA. 2000;284:450–6.
Villano SA, Vlahov D, Nelson KE, Cohn S, Thomas DL.
Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. Hepatology. 1999;29:908–14.
Luetkemeyer A, Hare CB, Stansell J, et al.
Clinical presentation and course of acute hepatitis C infection in HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41:31–6.
Dominguez S, Ghosn J, Valantin MA, et al.
Efficacy of early treatment of acute hepatitis C infection with pegylated interferon and ribavirin in HIV-infected patients. AIDS. 2006;20:1157–61.
Gilleece YC, Browne RE, Asboe D, et al.
Transmission of hepatitis C virus among HIV-positive homosexual men and response to a 24-week course of pegylated interferon and ribavirin. J Acquir Immune Defic Syndr. 2005;40:41–6.
Vogel M, Bieniek B, Jessen H, et al.
Treatment of acute hepatitis C infection in HIV-infected patients: a retrospective analysis of eleven cases. J Viral Hepat. 2005;12:207–11.
Vogel M, Nattermann J, Baumgarten A, et al.
Pegylated interferon-alpha for the treatment of sexually transmitted acute hepatitis C in HIV-infected individuals. Antivir Ther. 2006;11:1097–101.
Vogel M, Rockstroh J.
The Treatment of Chronic Hepatitis C Virus Infection in HIV Co-infection. Eur J Med Res. 2009;14:507–15.
Vogel M, Dominguez S, Bhagani S, et al.
Treatment of acute HCV infection in HIV-positive patients: experience from a multicentre European cohort. Antivir Ther. 2010;15:267–79.
Graham CS, Baden LR, Yu E, et al.
Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001;33:562–9.
Weber R, Sabin CA, Friis-Moller N, et al.
Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006;166:1632–41.
Broers B, Helbling B, Francois A, et al.
Barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J Hepatol. 2005;42:323–8.
Santantonio T, Fasano M, Sinisi E, et al.
Efficacy of a 24-week course of PEG-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance. J Hepatol. 2005;42:329–33.
Nomura H, Sou S, Tanimoto H, et al.
Short-term interferon-alfa therapy for acute hepatitis C: a randomized controlled trial. Hepatology. 2004;39:1213–9.
Dorward J, Garrett N, Scott D, Buckland M, Orkin C, Baily G.
Successful treatment of acute hepatitis C virus in HIV positive patients using the European AIDS Treatment Network guidelines for treatment duration. J Clin Virol. 2011;52:367–9.
Kiser JJ, Burton JR, Anderson PL, Everson GT.
Review and management of drug interactions with boceprevir and telaprevir. Hepatology. 2012;55:1620–8.
PubMed CrossRef Copyright information
© Society of General Internal Medicine 2012