Hepatitis B virus coinfection in human immunodeficiency virus-infected patients: A review

Table 2 Comparisons regarding the use of anti-hepatitis B virus agents in human immunodeficiency virus-infected patients among the different guidelines

	Agents for HBV treatment only	Agents for HBV/HIV treatment	Timing of cART initiation	Comments
DHHS 2013[82]	ADV, ETV, or LdT	TDF can safely be used: TDF/LAM-containing cART or TDF/FTC-containing cART TDF cannot safely be used: ETV plus LAM-cART, or ETV plus LAM-cART	HBV: NA HIV: prioritized; regardless of CD4 count	CART may attenuate liver disease progression by preserving or restoring immune function and reducing HIV-related immune activation and inflammation
EACS 2013[83]	ADV and LdT	LAM-naïve cART including TDF/LAM or FTC LAM-experienced Add or substitute 1 NRTI with TDF as part of cART HBV treatment indicated Early ART including TDF/FTC or LAM PEF-IFN (if genotype A, high ALT, low HBV DNA)	HBV: HBV DNA > 2000 IU/mL; significant liver fibrosis (F2-F4) even when HBV-DNA is below 2000 IU/mL and liver enzymes are not elevated HIV: CD4 < 500 cells/μL or symptomatic HIV, cirrhosis, or HBV treatment indicated	The optimal treatment duration for nucleos(t)ide analogues with anti-HBV activity has not yet been determined and experts recommend life-long therapy if anti-HBV nucleos(t)ides are given as part of ART In persons with HBV genotype A, high ALT and low HBV DNA, Peg-IFN might be used for a total treatment period of 48 wk. The addition of an NRTI-based anti-HBV regimen has not been proved to increase Peg-IFN efficacy In persons with liver cirrhosis, stopping effective anti-HBV treatment is not recommended in order to avoid liver decompensation due to flares of liver enzymes Anti-HBV therapy may be stopped cautiously in HBeAg-positive persons who have achieved HBe seroconversion for at least 6 mo or after confirmed HBs seroconversion in those who are HBeAg-positive The addition of ETV to TDF in persons with low persistent HB -replication has not been statistically proved to be efficient and should therefore be avoided Caution is warranted when switching from a TDF-based regimen to drugs with a lower genetic barrier, e.g., FTC or LAM, in particular in LAM-pretreated cirrhotic persons as viral breakthrough due to archived YMDD mutations is likely to occur
BHIVA 2013[84]	NA	CD4 count > 500 cells/μL: TDF/FTC-cART Unwilling or unable to receive TDF/FTC: ADV or 48 wk of PEG-IFN plus cART CD4 count < 500 cells/μL: Wild-type HBV: TDF/FTC-cART or TDF/LAM-cART LAM/FTC-resistant HBV or HIV: TDF as the sole anti-HBV active agent TDF is contraindicated: ETV plus cART	HBV: HBV DNA > 2000 IU/mL; more than minimal fibrosis on liver biopsy (Metavir > F2 or Ishak > S2) or indicative of > F2 by TE (FibroScan > 9.0 kPa) regardless of HBV DNA HIV: CD4 < 500 cells/μL or patients requiring HBV therapy	At least 2 baseline HBV DNA measurements 3 to 6 mo apart to guide initiation of therapy 6-mo HBV DNA measurements for routine monitoring of therapy An ALT level below the upper limit of normal (30 IU/L for men; 19 IU/L for women) should not be used to exclude fibrosis or as a reason to defer HBV therapy

ADV: Adefovir dipivoxil; ALT: Alanine aminotransferase; cART: Combination antiretroviral therapy; ETV: Entacavir; FTC: Emtricitabine; HBV: Hepatitis B virus; LAM: Lamivudine; LdT: Telbivudine; NA: Not available; Peg-IFN: Pegylated interferon; TDF: Tenofovir disoproxil fumarate; TE: Transient elastography.