HEPATITIS B AND HIV CO-INFECTION

  • Hepatitis B virus (HBV) is the leading cause of chronic liver disease among HIV patients. In Uganda, the prevalence of Hepatitis B among HIV patients is estimated to be at 17%. (See section 6.5.2 for more details on hepatitis
    B infection)
  • All HIV-infected patients initiating and those failing ART should be routinely screened for HBV infection using Hep B surface Antigen (HBsAg)
  • People living with HIV with a positive HBsAg should have other complementary tests at baseline and repeated every 6 months and these include:
    • A complete blood count
    • Liver function tests: ALT, AST, albumin, bilirubin, PT-INR
    • Liver ultrasound scan: to assess stage of liver fibrosis
  • Repeat tests every 6 months since patients with chronic HBV infection are at increased risk for hepatocellular carcinoma

Management of HBV/HIV co-infection

The goal of HBV/HIV treatment is to prevent dual disease progression and to reduce HBV-related morbidity and mortality.

TREATMENT

Preferably ART regimen containing:

  • TDF 300 mg + 3TC 300 mg PO once daily for life
  • After 6 months of treatment, patients should be evaluated for HBV treatment failure

If jaundice, malaise and abdominal right upper quadrant pain are present or if liver function tests are abnormal

  • Do HBV DNA (hepatitis viral load) if any of the above is present

Treatment Failure

  • Patients with HB VL >2000 IU/ml at 24 weeks of therapy should be referred for further evaluation and management

Prevention of HBV infection

  • Counseling: emphasize sexual transmission as well as the risks associated with sharing needles and syringes, tattooing or body-piercing
  • Advise patients with chronic HBV disease to avoid alcohol consumption
  • All household members and sexual partners of people living with HIV with HBV should be screened for HBsAG
  • HBV Vaccination is the most effective way to prevent HBV infection and its consequences
    • All HIV-infected patients who test negative on HBsAg should be vaccinated with HBV vaccine
    • All sexual partners and contacts should receive HBV vaccination regardless of whether they are HIV-infected or not.