Treatment of chronic HBV infection in HIV-positive individuals
CD4 < 500/µL
or
Symptomatic
HIV
or Cirrhosisa
No HBV Rx indicatedb
HBV Rx
Indicatedb
Lamivudine experienced
Lamivudine Naive
HAART
Including
TDFd,e+3TCd or FTCd
Add or substitute one NRTI with TDFd,eas part of HAART
Monitor
Closely
a) Early HAART including TDF + FTC/3TCc,d
b) PegINFd if Genotype A, high ALT, low HBV DNA
CD4 >500/µL AND
No indication for HAART
HIV/HBV
Co-infection
c) Naïve Asian,
HBe-Ag+, HIV coinfected patients initiating HAART with TDF or TDF+FTC reached
unexpected high rates of HBe (and even HBs) seroconversion, strengthening the
rationale for early HAART. If a patient is unwilling to go on early HAART,
adefovir and telbivudine may be used as an alternative to control HBV alone. A recent
case report suggested possible anti-HIV activity of telbivudine. In-vitro data
using
an assay which was able to demonstrate anti-HIV-activity of entecavir however,
failed to detect an influence of telbivudine on the replicative capacity of HIV-1.
Updated EACS
coinfection guidelines, EACS Cologne 11/2009