{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:29:18Z","timestamp":1786739358114,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>We report a case of a 46-year-old female living with HIV since 2010 who was originally from Malawi and had settled in the UK in 2001. She was admitted to our hospital with confusion and quickly noted to have a decreased Glasgow Coma Scale of 10\/15. Her biochemical parameters showed the presence of elevated liver function tests (LFTs), clotting abnormalities, and her ammonia were found to be &gt;400 mmol\/L with a severe metabolic acidosis (pH = 7.05). She was treated for HIV with combined antiretroviral therapy, namely tenofovir disoproxil fumarate, emtricitabine (FTC) and cobicistat boosted atazanavir 2 years previously and had normal LFTs at that time. Her HIV-1 viral load was 1400 copies\/ml on admission after recently having an undetectable viral load 2 months previously, and her CD4 count was 480. Her relevant past medical history included insulin-dependent diabetes mellitus. Her other medications included insulin, ramipril, sertraline, amitriptyline, and zopiclone. Toxicology and viral hepatitis screen were negative. Epstein Barr virus (EBV) serology showed evidence of previous exposure, but she was found to have a very high EBV viral load of 55,000 copies\/ml, which given her serology, was very likely to be a reactivation of EBV infection rather than a primary EBV infection. In the intensive care unit, the patient deteriorated and died very quickly. The postmortem examination showed extensive hepatic necrosis with collapse. To our knowledge, this is the first case report to show an association between EBV reactivation and fulminant hepatic failure in an individual living with HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmau.jmau_16_20","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T04:51:28Z","timestamp":1604897488000},"page":"41-44","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Reactivation of the Epstein\u2013Barr Virus Leading to Acute Liver Failure in a Patient Living with HIV"],"prefix":"10.4103","volume":"9","author":[{"given":"Mohamed H","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansoor","family":"Raza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Lucas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dushyant","family":"Mital","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-8-20240830","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1038\/nrgastro.2017.38","article-title":"Mechanisms of hepatic stellate cell activation","volume":"14","author":"Tsuchida","year":"2017","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R2-8-20240830","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/QAI.0000000000000992","article-title":"Poorly controlled HIV infection: An independent risk factor for liver fibrosis","volume":"72","author":"Kim","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"R3-8-20240830","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/QAD.0b013e3283511e91","article-title":"Immune reconstitution inflammatory syndrome: Incidence and implications for mortality","volume":"26","author":"Novak","year":"2012","journal-title":"AIDS"},{"key":"R4-8-20240830","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/S1473-3099(05)70216-4","article-title":"Global epidemiology of hepatitis C virus infection","volume":"5","author":"Shepard","year":"2005","journal-title":"Lancet Infect Dis"},{"key":"R5-8-20240830","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/hep4.1112","article-title":"Human immunodeficiency virus and liver disease: A comprehensive update","volume":"1","author":"Sherman","year":"2017","journal-title":"Hepatol Commun"},{"key":"R6-8-20240830","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1097\/QAD.0b013e32833a0918","article-title":"Factors associated with specific causes of death amongst HIV-positive individuals in the D: A: D Study","volume":"24","author":"Smith","year":"2010","journal-title":"AIDS"},{"key":"R7-8-20240830","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(14)60604-8","article-title":"Trends in underlying causes of death in people with HIV from 1999 to 2011 (D: A: D): A multicohort collaboration","volume":"384","author":"Smith","year":"2014","journal-title":"Lancet"},{"key":"R8-8-20240830","doi-asserted-by":"crossref","first-page":"9184","DOI":"10.3390\/ijms15069184","article-title":"Molecular mechanisms of liver fibrosis in HIV\/HCV coinfection","volume":"15","author":"Mastroianni","year":"2014","journal-title":"Int J Mol Sci"},{"key":"R9-8-20240830","first-page":"190","article-title":"Non-alcoholic fatty liver disease and HIV\/AIDS: A new way of modulation of cardiovascular risk","volume":"19","author":"Ahmed","year":"2017","journal-title":"AIDS Rev"},{"key":"R10-8-20240830","first-page":"031","article-title":"Boosting Dose of Ritonavir as a Cause of Widespread Hepatic Macrovesicular Steatosis","volume":"5","author":"D Mital","year":"2018","journal-title":"J J Gastro Hepato"},{"key":"R11-8-20240830","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fped.2019.00014","article-title":"Advances in the study of chronic active Epstein-Barr virus infection: Clinical features under the 2016 WHO classification and mechanisms of development","volume":"7","author":"Arai","year":"2019","journal-title":"Front Pediatr"},{"key":"R12-8-20240830","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1007\/s10620-014-3029-2","article-title":"Epstein-Barr virus (EBV) related acute liver failure: A case series from the US Acute Liver Failure Study Group","volume":"59","author":"Mellinger","year":"2014","journal-title":"Dig Dis Sci"},{"key":"R13-8-20240830","doi-asserted-by":"crossref","first-page":"74","DOI":"10.14740\/gr718e","article-title":"Epstein-Barr virus-associated acute liver failure present in a 67-year-old immunocompetent female","volume":"9","author":"Zhang","year":"2016","journal-title":"Gastroenterol Res"},{"key":"R14-8-20240830","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1002\/lt.500040612","article-title":"Fulminant Epstein-Barr viral hepatitis: Orthotopic liver transplantation and review of the literature","volume":"4","author":"Feranchak","year":"1998","journal-title":"Liver Transpl Surg"},{"key":"R15-8-20240830","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S0399-8320(07)91934-X","article-title":"EBV-induced fulminant hepatic failure: Favorable outcome after liver transplantation","volume":"31","author":"Dumortier","year":"2007","journal-title":"Gastroenterol Clin Biol"},{"key":"R16-8-20240830","doi-asserted-by":"crossref","first-page":"4130","DOI":"10.3748\/wjg.v16.i33.4130","article-title":"Epstein-Barr virus: Silent companion or causative agent of chronic liver disease?","volume":"16","author":"Petrova","year":"2010","journal-title":"World J Gastroenterol"},{"key":"R18-8-20240830","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1053\/jinf.2002.0993","article-title":"Fulminant hepatic failure and autoimmune hemolytic anemia associated with Epstein-Barr virus infection","volume":"45","author":"Palanduz","year":"2002","journal-title":"J Infect"},{"key":"R19-8-20240830","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1097\/00042737-200211000-00021","article-title":"Lethal liver failure in an elderly patient with hepatitis B superinfected with Epstein-Barr virus","volume":"14","author":"Jim\u00e9nez-S\u00e1enz","year":"2002","journal-title":"Eur J Gastroenterol Hepatol"}],"container-title":["Journal of Microscopy and Ultrastructure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/JMAU.JMAU_16_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:28:20Z","timestamp":1786735700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/JMAU.JMAU_16_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/jmau.jmau_16_20","relation":{},"ISSN":["2213-879X"],"issn-type":[{"value":"2213-879X","type":"print"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}