Human immunodeficiency virus as a possible cofactor in the development of fulminant hepatitis B in intravenous drug abusers.

Fulminant hepatitis B virus (HBV) infection is often attributable to co-infection with the delta agent. However, delta produces a variable pattern of illness in HBsAg-positive addicts. It is often not detectable in fulminant cases of hepatitis B, and other cofactors have been conjectured regarding the pathogenesis of fulminant HBV disease. We present the case of an intravenous drug abuser with severe hepatitis B and concomitant infection with human immunodeficiency virus. We conclude that dual infection with these two viruses may be a factor in the development of fulminant hepatitis B in i.v. drug abusers, and might account for the atypical clinical course often observed.