Case of the Month: HIV and Hepatitis B Co-Infection

Case summary

A physician asked about a 46-year-old man co-infected with hepatitis B (HBV) and HIV since 2004. This was the patient’s first office visit, and no previous medical records were available. The patient had developed anemia, possibly from zidovudine. The patient was taking tenofovir/emtricitabine/efavirenz (Atripla™), but had run out of medication two weeks prior to the office visit. The CD4 count was unknown, and the patient had no opportunistic infections. He is also taking entecavir. The patient had reported that his HBV viral load was not undetectable on tenofovir/emtricitabine/efavirenz (Atripla™) alone, so entecavir had been added to the treatment regimen. What should be considered with this HIV and HBV co-infection?

CCC consultant advice

Restarting this patient on tenofovir/emtricitabine/efavirenz and following up on the HBV viral load is indicated, as HBV viral load can take a long time to become undetectable. After 6-12 months, if the HBV viral load is still detectable, it may advisable to add entecavir. Alternatively, the patient could be returned to tenofovir/emtricitabine/efavirenz and entecavir simultaneously and monitor HBV VL. Continued monitoring of HIV viral load and CD4 count is indicated, as with any HIV mono-infected person.

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