The British HIV Association (BHIVA) has issued draft guidelines for the treatment of people coinfected with HIV and hepatitis B virus (HBV).
There are high rates of coinfection amongst the communities affected by HIV in the UK. At one London HIV clinic, 6% of gay men were coinfected with the two viruses. In parts of Africa there are coinfection rates of around 10% and the rate of coinfection in injecting drug users is thought to be around 8%.
The guidelines recommend that all HIV-positive patients should be tested for markers of HBV within a month of their HIV diagnosis. Those without evidence of HBV infection should be vaccinated against the virus, and should also receive vaccinations for hepatitis A. Liver function should be regularly checked in people who have had exposure to HBV.
Before anti-HIV therapy is considered, the HBV status of patients should be assessed. This will help guide treatment decisions, as some anti-HIV drugs (3TC and tenofovir) have an anti-HBV effect.
Co-infected patients should be counseled about the potential dangers of alcohol consumption, and about ways of reducing the risk of HBV transmission. Sexual and household contacts should be tested for HBV.
Babies born to mothers with HBV should be vaccinated against HBV at birth, and receive HBV post-exposure prophylaxis.
Patients with cirrhosis should be screened for liver cancer, and anti-HBV therapy should be considered for people with active viral replication and raised transaminase levels. However the panel states that the best time to start anti-HBV therapy has not been determined.
Anti-HIV drugs which have an effect against HBV (3TC and tenofovir) should only be given as part of an anti-HIV treatment regimen or in a clinical trial.
The guidelines panel invite comments on whether or not dual therapy with both 3TC and tenofovir be recommended for all patients with HIV and HBV as part of their antiretroviral regimen in the absence of evidence from a large randomised study. At present the only randomised data available report on eleven HIV/HBV co-infected participants in the Gilead 903 study, which randomised participants to receive either d4T or tenofovir in addition to 3TC and efavirenz. Are these data enough to support clinical guidelines? To view the poster presentation of these data, click here.
The panel recommend that interferon alpha and adefovir (when available) should be considered for people not on anti-HIV therapy.
The best time to start anti-HBV therapy has not been established.
To read the guidelines in pdf format click >here >here
Comments on the guidelines should be addressed to Gary.Brook@nwlh.nhs.uk.
Further information on this website
Hepatitis B - Overview
Hepatitis B - Factsheet
HIV and hepatitis - Booklet in the information for HIV-positive people series
3TC - Overview
Tenofovir- Overview