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.