CD4 cell count (cells/μL) HBV requiring treatment* HBV not requiring treatment HCV with immediate plan to start HCV treatment* HCV with no immediate plan to start HCV treatment *See BHIVA

guidelines for the management of hepatitis viruses in adults infected with HIV 2013 [31] for indications to treat hepatitis B and C We recommend patients with HIV and hepatitis B virus coinfection who have a CD4 cell count <500 cells/μL are treated with fully suppressive ART inclusive of anti-HBV active antivirals (1B). We recommend patients with HIV and HBV coinfection who have a CD4 cell count ≥500 cells/μL and who have an HBV-DNA ≥2000 IU/mL and/or evidence of more than minimal fibrosis (Metavir ≥F2) are treated with fully suppressive ART inclusive

of anti-HBV active antivirals (1C). Proportion of patients with a CD4 cell count ≥500 cells/μL and an HBV DNA ≥2000 IU/mL Selleckchem ABT199 and/or evidence of more than minimal Epigenetic inhibitor molecular weight fibrosis commencing ART inclusive of anti-HBV antivirals. Rationale. Because of the negative effect of immune depletion on HBV disease progression, the availability of single drugs with high level dual hepatitis B and HIV antiviral activity, and the increased risk of liver-related deaths in patients with CD4 cell counts ≥500 cells/μL, coinfected patients with active HBV disease (HBV viral load ≥2000 IU/mL or Metavir F2 or above) and those with CD4 cell counts below 500 cells/μL should start ART inclusive of anti-HBV active antivirals [2]. Patients new with CD4 cell counts ≥500 cells/μL and HBV DNA of <2000 IU/mL, minimal or no evidence of liver inflammation or fibrosis, and a repeatedly normal ALT should be given the option to commence treatment or defer and be monitored not less than 6-monthly with HBV DNA and ALT and at least yearly for evidence of fibrosis.

For more information on the indications to start treatment for hepatitis B infection please refer to the BHIVA guidelines for the management of hepatitis viruses in adults infected with HIV 2013 [31]. We recommend TDF/FTC as part of a fully suppressive ART combination should be given to all patients where HBV treatment is deemed necessary (1C). We recommend neither 3TC nor FTC be used as the sole active drug against HBV in ART due to the rapid emergence of HBV resistant to these agents (1B). We recommend 3TC/FTC may be omitted from the ART regimen and tenofovir be given as the sole anti-HBV active agent if there is clinical or genotypic evidence of 3TC/FTC-resistant HBV or HIV (1D). Proportion of patients with a CD4 cell count <500 cells/μL receiving TDF/FTC or TDF/3TC as part of a fully suppressive combination ART regimen. Proportion of patients receiving 3TC or FTC as the sole active drug against HBV in ART. TDF, FTC and 3TC are agents that have good antiviral activity against both HIV and hepatitis B.