We recommend TDF/FTC as part of a fully suppressive ART combination should be given to all patients where HBV treatment is deemed necessary (1C). 54. We suggest adefovir or 48 weeks of PEG-IFN are alternative options in patients unwilling or unable to receive TDF/FTC as part of a fully suppressive ART combination but requiring HBV therapy (2C). 55. We suggest PEG-IFN is only used in HBsAg-positive patients with a repeatedly raised ALT, low HBV DNA (<2 × 106 IU/mL), selleck products and minimal fibrosis, irrespective of HBeAg antigen status (2D). Lack of HBV DNA response (reduction to <2000 IU/mL at 12 weeks) should prompt discontinuation. Repeat testing should be performed 3-monthly to observe the presence of seroconversion (2C).
6.5 Antiviral treatment: CD4 count <500 cells/μL (Algorithm 2) 6.5.1 Recommendations 56. We recommend TDF/FTC or TDF/3TC as part of a fully suppressive combination ART regimen be used in those with confirmed or presumed sensitive HBV (1C). 57. We recommend where tenofovir is not currently being given as a component of ART it should
be added or substituted for another agent within the regimen if there is no contraindication (1C). 58. We recommend neither 3TC nor FTC be used as the sole active drug against HBV in ART due to the rapid emergence of HBV resistant to these agents (1B). 59. We recommend 3TC/FTC may be omitted from the antiretroviral regimen and tenofovir be given as the sole anti-HBV active agent if there is clinical or genotypic evidence of 3TC/FTC- resistant HBV or HIV (1D). 60. We recommend Rapamycin that in the presence of wild-type HBV, either FTC or 3TC can be given to patients requiring ART in buy Idelalisib combination with tenofovir (1B). 6.5.2 Good practice points 61. We recommend if patients
on suppressive anti-HBV therapy require a switch in their antiretrovirals due to HIV resistance to tenofovir and/or 3TC/FTC, their active anti-HBV therapy (tenofovir with or without 3TC/FTC) should be continued and suitable anti-HIV agents added. 62. We recommend if tenofovir is contraindicated, entecavir should be used if retaining activity. Entecavir should only be used in addition to a fully suppressive combination ART regimen. 6.5.3 Auditable outcomes Proportion of patients with a CD4 count <500 cells/μL receiving TDF/FTC or TDF/3TC as part of a fully suppressive combination ART regimen Proportion of patients avoiding 3TC or FTC as the sole active drug against HBV in ART 6.6 Antiviral treatment: Acute HBV 6.6.1 Recommendations 63. We recommend individuals with severe/fulminant acute HBV in the context of HIV should be treated with nucleosides active against hepatitis B (1D). 64. We recommend patients with severe/fulminant acute HBV receive ART inclusive of tenofovir and 3TC or FTC, or entecavir given with ART (1D). 6.6.2 Auditable outcome Proportion of patients with severe/fulminant acute HBV who receive ART inclusive of an antiviral active against HBV 7 Hepatitis delta (HDV) 7.1.1 Recommendations 65.