Managing Dual and Triple Infections in Clinical Practice (HIV/HBV/HCV)

Managing Dual and Triple Infections in Clinical Practice (HIV/HBV/HCV)

  • Always test for coinfections in appropriate settings as coinfections lead to higher liver-related complications vs. mono-infections.
  • All persons with HIV should be treated with potent antiretroviral therapy (irrespective of HIV RNA/CD4 counts), including those with HCV ± HBV coinfection.
  • HIV/HCV-coinfected persons should be treated and retreated the same as persons without HIV infection. Be aware of the complex drug interactions between direct-acting antivirals (DAA) and antiretroviral medications.
  • Treat all HBV in all HBsAg/HIV coinfection with dual nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) therapy with anti-HBV activity.
  • Incomplete HBV DNA suppression is associated with HCC in patients with HIV/ HBV - Add entecavir if needed. Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) may have adverse metabolic consequences.
  • Keep in mind the risk of HBV reactivation in cases of HCV/HBV and HIIV/HCV/ HBV coinfections.

Dr. Manoj Kumar Sharma

Dr. Manoj Kumar Sharma is an Associate Professor in Hepatology at ILBS. He has completed his DM-(Gastroenterology) from G B Pant Hospital, New Delhi in 2005.


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