Prolonged Cholestatic Hepatitis B as the Initial Presentation of HIV Coinfection: A Case Report
| Author | Turkan Tuzun | en |
| Orcid | Turkan Tuzun [0000-0003-0603-8731] | en |
| Issued Date | 2025-12-31 | en |
| Abstract | Introduction: Hepatitis B virus (HBV) infection remains a major global health problem, presenting with diverse clinical manifestations. The cholestatic form of acute HBV is rare and may indicate underlying comorbidities or coinfections. Human immunodeficiency virus (HIV) coinfection can profoundly alter the clinical course of HBV, leading to more severe and prolonged disease. Case Presentation: We report a 39-year-old man who presented with fatigue, anorexia, jaundice, and dark urine. Laboratory evaluation revealed markedly elevated bilirubin and transaminase levels, confirming acute HBV infection (HBsAg+, anti-HBc IgM+, HBeAg+). Initial virological assessment demonstrated HBV DNA 257,000 IU/mL, HIV RNA 77,800 copies/mL, and a CD4+ T-cell count of 374/mm3 at presentation. Antiretroviral therapy (ART) (bictegravir/emtricitabine/tenofovir alafenamide) was initiated but temporarily withheld when total bilirubin peaked at 29 mg/dL on day 19. Ursodeoxycholic acid was also withdrawn due to its potential contribution to cholestasis. The patient experienced persistent hyperbilirubinemia lasting 95 days, which gradually resolved with supportive therapy. The ART was successfully reintroduced without recurrent hepatotoxicity or immune reconstitution inflammatory syndrome (IRIS). At the third month of therapy, the HIV RNA level had declined markedly, and CD4+ counts had improved. Conclusions: This case highlights that prolonged cholestatic acute HBV may serve as the initial clinical clue to underlying HIV infection, reinforcing the importance of routine HIV screening in atypical HBV presentations and careful evaluation for viral versus drug-induced liver injury during ART initiation. | en |
| DOI | https://doi.org/10.5812/hepatmon-165783 | en |
| URI | https://brieflands.com/journals/hepatmon/articles/165783 | en |
| Keyword | Cholestatic Jaundice | en |
| Keyword | HIV Coinfection | en |
| Keyword | Acute Hepatitis B | en |
| Keyword | Antiretroviral Therapy | en |
| Keyword | Hyperbilirubinemia | en |
| Publisher | Brieflands | en |
| Title | Prolonged Cholestatic Hepatitis B as the Initial Presentation of HIV Coinfection: A Case Report | en |
| Type | Case Report | en |
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