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

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.  Key words: HIV prevention, seroconversion, elevated transaminases, STDs, liver toxicity, herbal medication, antibiotics, oral contraception, rapid progression to AIDS.