Page 151 - HIV/AIDS Guidelines

HIV/HBV-coinfected persons with cirrhosis.

• Need to discontinue medications active against HBV: The patient’s clinical course should be
monitored with frequent liver function tests. The use of adefovir dipivoxil, entecavir, or telbivudine to
prevent flares, especially in patients with marginal hepatic reserve such as persons with compensated or
8
decompensated cirrhosis, can be considered. These alternative HBV regimens should only be used in
addition to a fully suppressive ARV regimen.
• Need to change ART because of HIV resistance: If the patient has adequate HBV suppression, the
ARV drugs active against HBV should be continued for HBV treatment in combination with other
suitable ARV agents to achieve HIV suppression (AIII).

References

1. Spradling PR, Richardson JT, Buchacz K, et al. Prevalence of chronic hepatitis B virus infection among patients in the
HIV Outpatient Study, 1996-2007. J Viral Hepat. 2010.
2. Thio CL, Seaberg EC, Skolasky R, Jr., et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the
Multicenter Cohort Study (MACS). Lancet. 2002;360(9349):1921-1926.
3. Konopnicki D, Mocroft A, de Wit S, et al. Hepatitis B and HIV: prevalence, AIDS progression, response to highly active
antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS. 2005;19(6):593-601.
4. Hoffmann CJ, Seaberg EC, Young S, et al. Hepatitis B and long-term HIV outcomes in coinfected HAART recipients.
AIDS. 2009;23(14):1881-1889.

5. Bellini C, Keiser O, Chave JP, et al. Liver enzyme elevation after lamivudine withdrawal in HIV-hepatitis B virus co-
infected patients: the Swiss HIV Cohort Study. HIV Med. 2009;10(1):12-18.

6. Law WP, Dore GJ, Duncombe CJ, et al. Risk of severe hepatotoxicity associated with antiretroviral therapy in the HIV-
NAT Cohort, Thailand, 1996-2001. AIDS. 2003;17(15):2191-2199.

7. Wit FW, Weverling GJ, Weel J, et al. Incidence of and risk factors for severe hepatotoxicity associated with antiretroviral
combination therapy. J Infect Dis. 2002;186(1):23-31.

8. Dore GJ, Soriano V, Rockstroh J, et al. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected
patients following antiretroviral therapy interruption. AIDS. 2010;24(6):857-865.
9. McMahon MA, Jilek BL, Brennan TP, et al. The HBV drug entecavir - effects on HIV-1 replication and resistance. N
Engl J Med. 2007;356(25):2614-2621.
10. Benhamou Y, Bochet M, Thibault V, et al. Long-term incidence of hepatitis B virus resistance to lamivudine in human
immunodeficiency virus-infected patients. Hepatology. 1999;30(5):1302-1306.
11. Manegold C, Hannoun C, Wywiol A, et al. Reactivation of hepatitis B virus replication accompanied by acute hepatitis in
patients receiving highly active antiretroviral therapy. Clin Infect Dis. 2001;32(1):144-148.
12. Sulkowski MS, Thomas DL, Chaisson RE, et al. Hepatotoxicity associated with antiretroviral therapy in adults infected
with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA. 2000;283(1):74-80.
13. den Brinker M, Wit FW, Wertheim-van Dillen PM, et al. Hepatitis B and C virus co-infection and the risk for
hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection. AIDS. 2000;14(18):2895-2902.
14. Centers for Disease Control and Prevention (CDC). Guidelines for prevention and treatment of opportunistic infections
in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV
Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1-207.
15. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661-662.
16. Woo G, Tomlinson G, Nishikawa Y, et al. Tenofovir and entecavir are the most effective antiviral agents for chronic
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Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents J-3

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