Hepatitis B and E Co-Primary Infections in an HIV-1-Infected Patient

We report an autochthonous hepatitis E virus (HEV)-hepatitis B virus co-primary infection in a 41-year-old man having sex with men and infected with human immunodeficiency virus (HIV). This case prompts testing for HEV in HIV-infected patients with acute hepatitis even if primary infection with another hepatitis virus is diagnosed. CASE REPORT A 41-year-old man having sex with men (MSM) diagnosed in1997 with human immunodeficiency virus type 1 (HIV-1) infection (1) presented asthenia, abdominal pain, and dark urine specimens in September 2010. His CD4 T-lymphocyte count (CD4 count) was 222/mm3, and his plasma HIV-1 RNA level was 40 copies/ml (RealTime HIV; Abbott, Wiesbaden, Germany) under raltegravir, darunavir, and ritonavir. In June 2009, he was seronegative for hepatitis C virus (HCV) and hepatitis B virus (HBV) (Architect; Abbott), while primary hepatitis A virus (HAV) infection was diagnosed by detecting anti-HAV IgM (Ar-chitect; Abbott) and HAV RNA, as described previously (2). At admission, the alanine aminotransferase level was 2,620 IU/ml