Acute Hepatitis C in an HIV-Infected patient: A Case Report and Review of Literature

Abstract

With the decrease in transmission via transfusions and injection drug use, acute symptomatic hepatitis C is infrequently seen in developed countries. We report a case of a human immunodeficiency virus (HIV)-infected adult who presented with abdominal pain. His alanine aminotransferase was greater than sixty times the upper limit of normal without any evidence on examination of fulminant hepatic failure. His workup revealed an elevated hepatitis C viral level with a negative hepatitis C antibody. He was discharged once his liver function tests improved. As an outpatient, he had a recurrent bout of symptoms with an elevation of his alanine aminotransferase and hepatitis C viral levels that promoted anti-hepatitis C virus treatment. This case illustrates the importance of considering acute hepatitis C as a cause of acute hepatitis in HIV-infected men who have sex with men. While patients with acute symptomatic hepatitis C generally have a higher rate of spontaneous viral clearance compared to those with an insidious acute infection, most still progress to chronic hepatitis C infection, and patients with HIV coinfection carry a higher risk of progression to chronic disease.

Symptomatic Acute Hepatitis C Infection Following a Single Episode of Unprotected Sexual Intercourse

“…Sexual transmission of hepatitis C in men who have sex with men (MSM) is well recognised, but the literature mainly describes this in HIV-positive men, particularly those who engage in high-risk sexual practices [4, 5]. Routine sexual health screening for blood-borne viruses in this group currently excludes hepatitis C. Screening is considered only in high-risk individuals, specified as those who engage in traumatic sexual behaviour, those who engage in intravenous drug use (IVDU), those who engage in “chem sex,” and those known to be HIV positive or with lymphogranuloma venereum; unprotected sexual intercourse alone is not considered high-risk [6].…”