They are recommended agents in these guidelines for the treatment of HIV-1 infection. All hepatitis B coinfected individuals who start ART, should commence a regimen containing TDF and FTC. Hepatitis B treatment options for patients declining ART are discussed elsewhere [31]. If an individual becomes intolerant or is unable to commence a TDF-containing regimen, entecavir should be
used if retaining activity. Because entecavir demonstrates modest anti-HIV activity and can select for HIV resistance, it should only be used in addition to a fully suppressive combination ART regimen. No individual coinfected with hepatitis B should receive a regimen containing Tacrolimus in vitro 3TC or FTC monotherapy as its use may result in the selection of the YMDD mutation [4,5]. TDF resistance has not been clearly described and resistance is unlikely to provide an explanation for most cases of suboptimal responses to TDF. In combination with 3TC or FTC, it has been selleck chemicals demonstrated to be effective at suppressing HBV DNA, inducing HBeAg seroconversion, and
reducing the risk of HBV breakthrough [6]. Where there is primary non-response or partial response to HBV-active antivirals, or where there is virological breakthrough, assessment of drug adherence and HBV resistance testing should be undertaken. Coinfected individuals who need to start a new ART regimen for reasons such as ART virological failure should ensure that effective anti-hepatitis B therapy is continued in addition to their new ART regimen. Abrupt withdrawal of effective treatment may lead to a flare in hepatitis B replication with liver damage. This may be particularly severe in patients with cirrhosis. We recommend all patients with HIV and hepatitis C virus coinfection be assessed for HCV treatment (GPP). We suggest Tolmetin commencing ART when the CD4 cell count is greater than 500 cells/μL in all patients who are not to commence
HCV treatment immediately (2D). We recommend commencing ART when the CD4 cell count is less than 500 cells/μL in all patients who are not to commence anti-HCV treatment immediately (1B). We recommend commencing ART to optimize immune status before anti-HCV therapy is initiated when the CD4 cell count is between 350 and 500 cells/μL unless there is an urgent indication for anti-HCV treatment when ART should be commenced as soon as the patient has been stabilized on HCV therapy (GPP). We recommend commencing ART to allow immune recovery before anti-HCV therapy is initiated when the CD4 cell count is less than 350 cells/μL (GPP). Proportion of patients with a CD4 cell count <500 cells/μL commencing ART. HIV has an impact on hepatitis C infection. Individuals with HCV coinfection have higher HCV viral loads, faster rates of fibrosis progression and an increased risk of cirrhosis compared to those with HCV alone.
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