PMC3902409_01
The ALT, AST, bilirubin levels and lymphocytes counts in an HBV/HIV coinfected patient experiencing a spontaneous HBV reactivation. (A) The ALT, AST and bilirubin levels were monitored regularly from 2006 to 2009. The ALT and AST levels were plotted at the left Y-axis and the bilirubin level at the right Y-axis. The insert indicated the ALT, AST and bilirubin levels during the flare-up phase, the black arrows indicated the sampling time for sequencing. (B) The lymphocytes counts were monitored regularly from 2006 to 2009. The relative CD4+ T cell counts in the CD3+ T cell population (CD4 +%) was set at the right Y-axis. The black arrow indicated the start of the antiviral therapy.
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F1
Since the patient had no HIV-associated symptoms and stable numbers of CD4 positive T helper cells > 500/mul (Figure 1B) with a relatively low HIV viremia (< 100,000 copies/ml) he did not receive a highly active antiretroviral therapy (HAART). In April 2008 the patient was admitted to hospital due to an acute icteric hepatitis with elevated serum transaminases (AST and ALT > 1000 U/mL) and cholestasis (total bilirubin more than 9.2 mg/dl) (Figure 1A).