Abstract
We describe a patient infected with human immunodeficiency virus who possessed a serological profile suggesting a previous cleared acute hepatitis B virus (HBV) infection, including high levels of antibodies against HBV surface antigen (anti-HBs). Following the administration of inhaled glucocorticosteroids combined with protease inhibitor-based antiretroviral treatment, the patient developed an unexpected severe acute hepatitis despite persistence of anti-HBs. A genotype A2 strain emerged with 2 major mutations in the S gene, sK122R and sD144E. Molecular and biological analyses strongly suggested reactivation of a latent HBV infection. The importance and the molecular basis of these 2 epitopes in immune-escape mechanisms and host-virus interactions are discussed.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
MeSH terms
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Administration, Inhalation
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Adrenal Cortex Hormones / administration & dosage
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Adrenal Cortex Hormones / adverse effects*
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Amino Acid Substitution
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Anti-HIV Agents / administration & dosage
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Antiretroviral Therapy, Highly Active / methods
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Epitopes / genetics
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Epitopes / immunology
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Genotype
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HIV Infections / complications*
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Hepatitis B / diagnosis*
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Hepatitis B / immunology
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Hepatitis B / pathology
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Hepatitis B Antibodies / blood
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Hepatitis B Surface Antigens / genetics
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Hepatitis B virus / classification
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Hepatitis B virus / genetics
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Hepatitis B virus / immunology
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Hepatitis B virus / pathogenicity*
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Humans
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Immune Evasion
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / adverse effects*
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Male
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Middle Aged
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Mutation, Missense
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Virus Activation / drug effects*
Substances
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Adrenal Cortex Hormones
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Anti-HIV Agents
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Epitopes
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Hepatitis B Antibodies
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Hepatitis B Surface Antigens
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Immunosuppressive Agents