SHM Converge Scientific Abstract ePoster Gallery-Vanished but With a Trace: Spontaneous Resolution of Chronic Hepatitis C in a Patient With Hiv

Pdf Summary

This case describes a 43-year-old man with HIV, cirrhosis from chronic hepatitis C, alcohol use disorder, and prior IV drug use who presented with abdominal pain, distension, vomiting, and decreased urination. He had stopped antiretroviral therapy two months before admission after being intermittently adherent. On exam, he had diffuse abdominal tenderness with guarding and rigidity. Laboratory studies showed severe anemia, elevated liver enzymes near baseline, and advanced immunosuppression with a CD4 count of 51 cells/mm³. Despite his history of untreated hepatitis C, his HCV RNA was undetectable.<br /><br />Imaging revealed ascites and a liver mass, and CT showed extensive abdominal involvement. Biopsy of the liver mass and lymph nodes confirmed hepatocellular carcinoma (HCC). The patient was found to have hepatitis C genotype 3a, a subtype associated with a higher chance of spontaneous viral clearance, though IL28B polymorphism testing was not performed.<br /><br />The report highlights that spontaneous resolution of chronic hepatitis C is rare, but has been observed in some patients with HIV/HCV coinfection after starting antiretroviral therapy. Immune reconstitution is considered the most likely explanation. In this patient, HCV became undetectable about two years after ART initiation. However, he later developed HCC, likely related to underlying cirrhosis from hepatitis C and alcohol use rather than ongoing viremia.<br /><br />The authors emphasize that spontaneous hepatitis C clearance can occur in HIV-positive patients, especially those with genotype 3 infection and favorable IL28B variants. Nonetheless, viral clearance does not eliminate the risk of hepatocellular carcinoma once cirrhosis is established. The patient chose comfort-focused care and was discharged to inpatient hospice.

Asset Subtitle

Aparna Rathnam

Meta Tag

Author List Alberto Busmail Haylock, Aparna Rathnam, Bibhuti Adhikari, Harleen K. Sidhu, Maurice Policar, Thanushiree Sivalingam

Category Clinical Vignettes

Concept Spontaneous HCV Clearance

Concept Hepatocellular Carcinoma

Concept Hepatitis C Infection

Concept HIV/HCV Coinfection

Concept HIV Therapy

Distinguished Non-Finalist

Presenter Organization NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai.

Presenting Author Aparna Rathnam

Track Adult

Keywords

HIV

hepatitis C

spontaneous viral clearance

hepatocellular carcinoma

cirrhosis

genotype 3a

antiretroviral therapy

immune reconstitution

CD4 count

alcohol use disorder

Spontaneous HCV Clearance

Hepatocellular Carcinoma

Hepatitis C Infection

HIV/HCV Coinfection

HIV Therapy