Hep B and HIV

Question 1

Hepatitis B virus and HIV

Answer 1

• If newly diagnosed with Hep B, then should check for Hep A, Hep C and Hep delta as well
• LFTs should be repeated at 2 weeks after commencing cART to detect hepatotoxicity or immune reconstitution inflammatory syndrome (IRIS) and then monitored throughout pregnancy and postpartum
• Where pegylated interferon or adefovir is being used to treat HBV in a woman who does not yet require HIV treatment who discovers she is pregnant, treatment should be switched to a tenofovir-based cART regimen
• Lamivudine or emtricitabine should not be used as the only active drug against HBV in cART because of the likelihood of HBV resistance to these agents
• If no obstetric complications, normal vaginal delivery can be recommended, if the mother has fully suppressed HIV viral load on cART
• Neonatal immunization with or without HBIG should commence within 24 hours of delivery

Question 2

Hep A vaccine in Hep coinfection

Answer 2

• In all HAV non-immune HBV co-infected women, HAV vaccine is recommended, after the first trimester, as per the normal schedule (0 and 6–12 months)
• If CD4

Question 3

Hep B and post delivery ART

Answer 3

• Where the pre-cART CD4 cell count is > 500 cells/μL, transaminases are normal, HBV DNA

Question 4

Hep C and HIV

Answer 4

As per Hep B