Scientific letter
HIV-1 primary infection and acute hepatitis A: Beware of co-infection!
Primoinfección por VIH-1 y hepatitis A aguda: cuidado con la co-infección
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "345" "paginaFinal" => "347" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Natalia Anahí Díaz, Juan Ambrosioni" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Natalia Anahí" "apellidos" => "Díaz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Juan" "apellidos" => "Ambrosioni" "email" => array:1 [ 0 => "AMBROSIONI@clinic.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Infectious Diseases Service, Hospital Cesar Milstein, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Infectious Diseases Service, Hospital Clinic-IDIPABS, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primoinfección por VIH-1 y hepatitis A aguda: cuidado con la co-infección" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2799 "Ancho" => 2500 "Tamanyo" => 446545 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Serologies and molecular markers performed at admission. (B) Time line of HAV and HIV serological, biochemical and virological markers of the index case. On the background, laboratory staging of HIV infection. ART: antiretroviral therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report a case of a 27-year-old man without relevant medical history. He was born in Costa Rica and was at that moment visiting Barcelona. He presented to the emergency department with a 3-day history of fever, headache and polyarthralgia. On clinical exam hepatosplenomegaly, jaundice and fever (39<span class="elsevierStyleHsp" style=""></span>°C) were documented. He referred a negative HIV serology performed 6 months before in his country, and reported sex with other men.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Initial laboratory test revealed altered liver parameters. Total bilirubin was 6.5<span class="elsevierStyleHsp" style=""></span>mg/dL (predominantly conjugated), aspartate aminotransferase 885<span class="elsevierStyleHsp" style=""></span>IU/L, alanine aminotransferase 2847<span class="elsevierStyleHsp" style=""></span>IU/L, alkaline phosphatase 238<span class="elsevierStyleHsp" style=""></span>IU/L, gamma-glutamyl transferase 864<span class="elsevierStyleHsp" style=""></span>IU/L and prothrombin time 67%.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to geographical origin of the patient, laboratory results and clinical presentation, primary hepatotropic viruses serologies (HAV, HBV, HCV, HDV, HEV) and viral load, EBV, CMV, dengue, chikungunya, syphilis serologies and HIV 1/2 4th generation EIA were requested (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Acute hepatitis A infection was diagnosed, also with serological evidence to previous exposure to dengue, syphilis, CMV and EBV.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Re-exploring the patient 24<span class="elsevierStyleHsp" style=""></span>h later, polyadenopathies and rash were identified, unnoticed the day before. HIV-1 viral load was then requested, being >10,000,000<span class="elsevierStyleHsp" style=""></span>copies/ml and CD4+ T cells count was 224/mm<span class="elsevierStyleSup">3</span> (17%). Retrospectively repeated EIA from that day resulted now positive, only 24<span class="elsevierStyleHsp" style=""></span>h later than the previously negative. Concomitant acute hepatitis A and severe acute primary HIV infection (PHI) were then the final diagnoses. TDF/FTC/dolutegravir at usual doses were immediately started with rapid remission of symptoms and liver tests progressive improvement over the following weeks. Virological, immunological and biochemical markers are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A week later the patient's partner, a 65-year-old Spanish man, presented at hospital, reporting their last sexual intercourse being 18 days before. He had HIV negative test 2 years ago and was asymptomatic at that moment. HIV RNA, IgM and IgG HAV were requested. HAV vaccine/immune globulin was indicated depending on the results, but he decided to perform laboratory tests in another hospital. A week later he returned to the emergency department with fever and altered liver parameters. IgG and IgM HAV were positive confirming acute hepatitis A, HIV-1 viral load was undetectable, excluding HIV-1 infection.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">PHI can co-exist with other sexually transmitted infections (such as HAV) thus health professionals should be aware and always suspect them. PHI clinical symptoms may be non-specific and results of diagnostic tests rapidly modify, as in the current case, in 24<span class="elsevierStyleHsp" style=""></span>h. Sexual intercourse during PHI is associated to high transmission risk due to uncontrolled viral replication and extremely high HIV viral load in this phase, with frequent unawareness of infection.</p><p id="par0035" class="elsevierStylePara elsevierViewall">About 20% of diagnosis in Spain and other European countries are made during acute infection (detection of p24 Ag and/or HIV-RNA in absence of HIV antibody) or during recent infection (HIV antibody detection up to 6 months after infection).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Immediate ART initiation controls symptoms, minimize viral reservoirs and decrease transmissibility.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Hepatitis A is an acute, self-limiting disease transmitted by faecal–oral route through contaminated food or water or through person-to-person contact, including sexual contact. If sexual transmission of HAV is suspected, particularly among men-who-have-sex-with-men (MSM), PHI should be excluded. PHI presents clinically as a mononucleosis-like or flu-like syndrome, easily missed in the context of a concomitant acute hepatitis. HAV incubation period could potentially be shorter than serological evidence of HIV infection. HIV RNA become positive 7–10 days after HIV exposure, p24-antigen approximately 14 days and HIV antibodies at around 21 days.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Thus, if concomitant or near exposure to HAV and HIV are suspected, HIV RNA should be requested to exclude PHI. HIV-VL is frequently extremely high in this period, with increased transmission risk. Complete seroconversion to HIV takes approximately 3 months until last WB band become positive (usually p31 band).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sexually transmitted outbreaks of acute hepatitis A have been reported in the last years in Europe among MSM, particularly HIV-positive.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–9</span></a> Hepatitis A infection is not more severe among HIV-infected individuals, but HAV viraemia is higher and longer, increasing transmission risk. In high-income countries anti-HAV IgG in general population is usually low (<50% by the age of 30 years).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Therefore, when HAV is introduced in groups at particular high-risk, as MSM population, outbreaks may occur, stressing the importance of preventive measures, particularly vaccination. As for HBV and HCV, HAV must also be considered as a potential co-infection in the context of PHI.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">JA has received research funding from Gilead Sc and ViiV Healthcare, out of the current work.</p><p id="par0055" class="elsevierStylePara elsevierViewall">NAD: none to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2799 "Ancho" => 2500 "Tamanyo" => 446545 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Serologies and molecular markers performed at admission. 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Castelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Infez Med" "fecha" => "2018" "volumen" => "26" "paginaInicial" => "46" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29525797" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis a outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Charre" 1 => "C. Ramiere" 2 => "A.M. Roque-Afonso" 3 => "C. Chidiac" 4 => "F. Zoulim" 5 => "M. 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Heinsbroek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eurosurveillance" "fecha" => "2017" "volumen" => "22" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Carrillo-Santisteve" 1 => "L. Tavoschi" 2 => "E. Severi" 3 => "S. Bonfigli" 4 => "M. Edelstein" 5 => "E. Byström" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(17)30392-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "e306" "paginaFinal" => "e319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28645862" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000003800000007/v1_202008020636/S0213005X19303192/v1_202008020636/en/main.assets" "Apartado" => array:4 [ "identificador" => "8590" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000003800000007/v1_202008020636/S0213005X19303192/v1_202008020636/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X19303192?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 1 | 9 |
| 2024 October | 22 | 6 | 28 |
| 2024 September | 34 | 3 | 37 |
| 2024 August | 27 | 6 | 33 |
| 2024 July | 34 | 4 | 38 |
| 2024 June | 25 | 2 | 27 |
| 2024 May | 21 | 5 | 26 |
| 2024 April | 24 | 4 | 28 |
| 2024 March | 51 | 4 | 55 |
| 2024 February | 48 | 6 | 54 |
| 2024 January | 42 | 0 | 42 |
| 2023 December | 36 | 6 | 42 |
| 2023 November | 60 | 4 | 64 |
| 2023 October | 70 | 1 | 71 |
| 2023 September | 41 | 1 | 42 |
| 2023 August | 42 | 6 | 48 |
| 2023 July | 29 | 2 | 31 |
| 2023 June | 31 | 1 | 32 |
| 2023 May | 63 | 3 | 66 |
| 2023 April | 46 | 5 | 51 |
| 2023 March | 27 | 1 | 28 |
| 2023 February | 27 | 2 | 29 |
| 2023 January | 33 | 3 | 36 |
| 2022 December | 40 | 8 | 48 |
| 2022 November | 52 | 10 | 62 |
| 2022 October | 31 | 5 | 36 |
| 2022 September | 27 | 10 | 37 |
| 2022 August | 32 | 9 | 41 |
| 2022 July | 23 | 5 | 28 |
| 2022 June | 34 | 7 | 41 |
| 2022 May | 30 | 19 | 49 |
| 2022 April | 55 | 10 | 65 |
| 2022 March | 75 | 6 | 81 |
| 2022 February | 71 | 6 | 77 |
| 2022 January | 47 | 10 | 57 |
| 2021 December | 31 | 7 | 38 |
| 2021 November | 31 | 9 | 40 |
| 2021 October | 25 | 14 | 39 |
| 2021 September | 27 | 5 | 32 |
| 2021 August | 28 | 3 | 31 |
| 2021 July | 30 | 9 | 39 |
| 2021 June | 17 | 6 | 23 |
| 2021 May | 23 | 3 | 26 |
| 2021 April | 55 | 3 | 58 |
| 2021 March | 11 | 7 | 18 |
| 2021 February | 28 | 6 | 34 |
| 2021 January | 4 | 2 | 6 |
| 2020 November | 3 | 0 | 3 |
| 2020 October | 1 | 0 | 1 |
| 2020 September | 6 | 6 | 12 |
| 2020 August | 57 | 19 | 76 |
| 2020 May | 0 | 2 | 2 |
| 2020 February | 0 | 2 | 2 |
| 2020 January | 0 | 4 | 4 |
Show all
