What are the AASLD recommendations for treatment of individuals with hepatitis B (HBV) (Hep B) and HIV infection?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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In individuals with HBV/human immunodeficiency virus (HIV) coinfection, the AASLD recommends initiating ART in (1) all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as (2) those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage. [55] (Strong recommendation)

However, the AASLD does not recommend  antiviral therapy, indicating it can be deferred, in individuals with all of the following , regardless of HBeAg status or age (strong recommendation) [55] :

  • No clinical evidence of cirrhosis (or based on APRI score ≤2 in adults)
  • Persistently normal ALT levels
  • Low levels of HBV DNA replication (HBV DNA < 2,000 IU/mL). (If HBV DNA testing is unavailable, treatment can be deferred in HBeAg-positive individuals aged 30 years or younger who have persistently abnormal ALT levels. (Conditional recommendation)]

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