Persisting HIV-1 replication triggered by acute hepatitis A virus infection

We report the case of two patients in whom acute hepatitis A was associated with a marked and prolonged increase in human immunodeficiency virus type 1 (HIV-1) viral load. Although in one patient the rise in HIV-1 RNA might a lso have been related to the interruption of antiretroviral therapy, we als o observed a similar pattern in the other patient who had a stable undetect able plasma viraemia prior to acute hepatitis and never received treatment with antiretrovirals. Our observation supports the hypothesis that immune a ctivation that is induced by acute hepatitis A virus (HAV) infection may tr igger HIV-1 replication. This highlights the importance of maintaining anti retroviral therapy throughout the acute phase of hepatitis A and of prevent ing HAV infection through active immunization.