{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:31:45Z","timestamp":1791919905206,"version":"4.3.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T00:00:00Z","timestamp":1661731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>HIV and hepatitis B virus (HBV) coinfection is relatively common. Initiation of antiretroviral therapy (ART) in people with HIV (PWH) causes a progressive restoration of cell-mediated immune functions. In the presence of overt or occult coinfections, immune restoration might lead to immune reconstitution inflammatory syndrome (IRIS). Here, we describe the clinical, immunological, virological, and histological characterization of a case of HBV-related IRIS hepatitis in a PWH after ART initiation. A liver biopsy was performed during HBV-related IRIS hepatic flare, and liver samples were analyzed through immunohistochemistry and molecular techniques, with the assessment of intrahepatic HBV-DNA, covalently closed circular DNA, and HBV pregenomic RNA through a droplet digital polymerase chain reaction system. Immune activation and senescence were also longitudinally assessed. In this clinical case, the hepatic flare occurred 6 weeks after ART initiation with a therapeutic regimen including tenofovir alafenamide (TAF) and emtricitabine (FTC). The episode was self-limiting, characterized by hyperactivation of peripheral blood CD4+ and CD8+ T-lymphocytes, and resolved without ART discontinuation, leading to the achievement of HBsAg seroconversion (HBsAg-\/HBsAb+) and HBV-DNA plasma undetectability. Notably, hyperactivation of the immune system plays a pivotal role in promoting the control of HBV replication, thus triggering the achievement of HBsAg seroconversion during treatment with TAF\/FTC.<\/jats:p>","DOI":"10.1093\/ofid\/ofac451","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T06:18:00Z","timestamp":1661753880000},"source":"Crossref","is-referenced-by-count":12,"title":["Hepatitis B\u2013Related Hepatic Flare During Immune Reconstitution Syndrome After Antiretroviral Treatment Initiation in an HBV Surface Antigen\u2013Positive Patient With HIV: Viroimmunological and Histological Characterization"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-8627","authenticated-orcid":false,"given":"Marco","family":"Iannetta","sequence":"first","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M A","family":"Crea","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Campogiani","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Teti","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-5298","authenticated-orcid":false,"given":"Vincenzo","family":"Malagnino","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Compagno","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Coppola","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Piermatteo","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampiero","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Cimino","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Salpini","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A","family":"Zingaropoli","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0894-6496","authenticated-orcid":false,"given":"Maria R","family":"Ciardi","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1286-467X","authenticated-orcid":false,"given":"Claudio M","family":"Mastroianni","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio G","family":"Parisi","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, University of Padova , Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2377-504X","authenticated-orcid":false,"given":"Valentina","family":"Svicher","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Tor Vergata University , Rome , Italy"},{"name":"Department of Biology, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Andreoni","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Sarmati","sequence":"additional","affiliation":[{"name":"Department of System Medicine, Tor Vergata University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,29]]},"reference":[{"key":"2022092702291566200_ofac451-B1","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1001\/jama.2013.276701","article-title":"Thirty-year outcomes of the national hepatitis B immunization program in Taiwan","volume":"310","author":"Chiang","year":"2013","journal-title":"JAMA"},{"key":"2022092702291566200_ofac451-B2","first-page":"609","article-title":"Epidemiology of HCV and HBV in a high endemic area of Southern Italy: opportunities from the COVID-19 pandemic-standardized national screening or one tailored to local epidemiology?","volume":"11","author":"Nevola","year":"2022","journal-title":"Biology (Basel)"},{"key":"2022092702291566200_ofac451-B3","doi-asserted-by":"crossref","first-page":"7635","DOI":"10.3748\/wjg.v20.i24.7635","article-title":"Epidemiology of acute and chronic hepatitis B and delta over the last 5 decades in Italy","volume":"20","author":"Sagnelli","year":"2014","journal-title":"World J Gastroenterol"},{"issue":"Suppl 1","key":"2022092702291566200_ofac451-B4","doi-asserted-by":"crossref","first-page":"i47","DOI":"10.1136\/gutjnl-2012-302062","article-title":"HIV And viral hepatitis coinfections: advances and challenges","volume":"61","author":"Lacombe","year":"2012","journal-title":"Gut"},{"key":"2022092702291566200_ofac451-B5","doi-asserted-by":"crossref","first-page":"11942","DOI":"10.1038\/s41598-019-46976-1","article-title":"HBcab seropositivity is correlated with poor HIV viremia control in an Italian cohort of HIV\/HBV-coinfected patients on first-line therapy","volume":"9","author":"Malagnino","year":"2019","journal-title":"Sci Rep"},{"key":"2022092702291566200_ofac451-B6","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1038\/s41598-021-83616-z","article-title":"Poor CD4\/CD8 ratio recovery in HBcAb-positive HIV patients with worse immune status is associated with 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