Elevated liver transaminases, human immune deficiency virus (HIV) seroconversion and rapid progression to AIDS in a HIV prevention clinical trial participant: A case report

Abstract

This is a case report on a human immune deficiency virus (HIV) prevention trial participant who HIV 
seroconverted, developed hepatitis and rapidly progressed to acquired immunodeficiency syndrome 
(AIDS). A 24 year old HIV negative, non-pregnant participant consented to participate in the FEM-PrEP 
clinical trial. Her baseline parameters were normal; she was on oral contraception and was vaccinated 
for hepatitis B. She attended monthly scheduled visits and protocol specific procedures were done. She 
HIV seroconverted at her week 36 follow up visit, and her aspartate aminotransferases (ASTs) and 
alanine aminotransferases (ALTs) were elevated to a grade 3 level (DAIDs grading). Over her next follow 
up visits, there were fluctuations in her AST and ALTs and she had a history of using herbal medication. 
She rapidly progressed to AIDS and was started on anti-retroviral (ARVs). The participant was in the 
Truvada arm of the study. This case of hepatic toxicity and rapid HIV progression demonstrates the 
clinical complexity of HIV management in clinical trials. We hypothesize that the hepatic toxicity was 
associated with acute HIV infection and concomitant use of herbal medicine; however, we cannot 
definitively demonstrate causality.