Hepatitis A virus infection in an HIV-positive man with previously confirmed immunity against hepatitis A virus
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CASE REPORT
Hepatitis A virus infection in an HIV‑positive man with previously confirmed immunity against hepatitis A virus Yukihiro Yoshimura1 · Hiroshi Horiuchi1 · Nobuyuki Miyata1 · Makiko Kondo2 · Natsuo Tachikawa1 Received: 5 September 2019 / Accepted: 29 January 2020 © Japanese Society of Gastroenterology 2020
Abstract A Japanese man with human immunodeficiency virus (HIV) was detected 9 years ago to have a positive titer for hepatitis A virus (HAV) immunoglobulin (Ig) G, without a history of HAV infection or vaccination. His plasma HIV RNA was wellcontrolled on antiretroviral therapy for more than 6 years. He developed HAV infection with subsequent reduction of the HAV IgG titer. A decreasing HAV IgG in persons living with HIV might indicate the possibility of HAV reinfection and should prompt the consideration for additional vaccination. Keywords Hepatitis A · HIV · Immunoglobulin · Reinfection
Introduction Hepatitis A virus (HAV) causes an acute infection that is common in conditions without adequate hygiene and sanitation and has been recently reported to cause outbreaks among men who have sex with men (MSMs), people who use drugs, and homeless people in developed countries [1–3]. HAV is transmitted by the fecal–oral route during sexual activities, MSMs are at a high risk for both HAV and human immunodeficiency virus (HIV) infection [4]. The clinical course of acute hepatitis A was reported to be more symptomatic and protracted in MSMs and HIV-positive population than in sporadic cases in the general population [2]. Notably, a previous infection with HAV was suggested to confer life-long immunity to HAV [5].
Case report A 42-year-old Japanese man with HIV and had been on antiretroviral therapy (ART) for 9 years was presented to the Yokohama Municipal Citizen’s Hospital with a 7-day history * Yukihiro Yoshimura [email protected] 1
Yokohama Municipal Citizen’s Hospital, 56 Okazawa‑cho, Hodogaya‑ku, Yokohama 240‑8555, Japan
Kanagawa Prefectural Institute of Public Health, 1‑3‑1 Shimoya‑cho, Chigasaki, Kanagawa 253‑0087, Japan
2
of fever and severe fatigue. Nine years ago, his plasma HAV immunoglobulin (Ig) G index was 3.3 (cutoff value, 1.0) by chemiluminescent immunoassay (HAVAB-G®, Abbott Japan Co., Ltd.). The patient did not have prior HAV vaccinations or HAV infection. Before the start of ART, his nadir CD4+ lymphocyte count was 256/μL, his maximum plasma HIV RNA level was 210,000 copies/mL, and he had no signs of acquired immunodeficiency syndrome. Four years ago, he had an acute hepatitis C virus (HCV) infection and was treated with pegylated interferon, which resulted to a sustained virologic response for 24 weeks posttreatment. He was an MSM and would engage in unprotected receptive anal intercourse with casual partners several times a month. He was a social drinker and took alcohol once a month and took lamotrigine, valproic acid, brotizolam and quetiapine for bipolar depression. He traveled to Thailand before the first presentation, but had no travel history for the last 9 years. H
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