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. 2011 Fall;22(3):88-96.
doi: 10.1155/2011/686918.

Management and treatment of hepatitis B virus in patients with HIV infection: A practical guide for health care professionals

Marina B Klein  1 , Jean-Guy Baril, Marc-André Charron, Claude Fortin, Richard Lalonde, Marie-France Matte, Marc Poliquin, Annie Talbot, Rachel Therrien, Cécile Tremblay, Benoît Trottier, Irina Tsarevsky, Jean-Pierre Villeneuve
Affiliations

Management and treatment of hepatitis B virus in patients with HIV infection: A practical guide for health care professionals

Marina B Klein et al. Can J Infect Dis Med Microbiol. 2011 Fall.

Abstract
in English, French

The management and treatment of HIV and hepatitis B virus (HBV)-coinfected patients present specific challenges for clinicians. The morbidity and mortality related to these concomitant infections are growing concerns, while the use of antiviral drugs effective against both viruses complicates therapeutic decision making. The present document provides guidelines for physicians regarding care and treatment of patients coinfected with HIV and HBV. Primary prevention of HBV in HIV-positive patients is achieved through appropriate vaccination schedules. Follow-up before treatment of HBV may include liver biopsy, screening for hepatocellular carcinoma and testing for esophageal varicies in cases of cirrhosis. In HBV-infected patients requiring treatment, recommendations regarding initiation, duration and choice of first-line drugs are made. Finally, in the case of resistance, appropriate alternative therapies are necessary.

La prise en charge et le traitement des patients co-infectés par le VIH et le virus de l’hépatite B (VHB) comportent des défis précis pour les cliniciens. La morbidité et la mortalité liées à ces infections concomitantes sont de plus en plus inquiétantes, tandis que l’utilisation d’antiviraux efficaces contre les deux virus complique les décisions thérapeutiques. Le présent document contient des lignes directrices pour les physiciens au sujet des soins et du traitement des patients co-infectés par le VIH et le VHB. La prévention primaire du VHB chez les patients atteints du VIH s’obtient par un calendrier de vaccination bien planifié. Le suivi avant le traitement du VHB peut inclure une biopsie hépatique, le dépistage du carcinome hépatocellulaire et des tests en vue de déceler des varices œsophagiennes en cas de cirrhose. À l’égard des patients infectés par le VHB qui ont besoin d’être traités, on présente des recommandations portant sur l’amorce, la durée et le choix des médicaments de premier recours. Enfin, en cas de résistance, de nouvelles thérapies pertinentes s’imposent.

Keywords: Antiretroviral therapy; HIV; HIV coinfection; Hepatitis B; Resistance; Vaccination.

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Figures

Figure 1)
Figure 1)
Procedure for following posthepatitis B virus (HBV) vaccination surface antibody (anti-HBs) levels in people living with HIV. *Measure anti-HBs one to six months after the end of the vaccine series. Although no specific data exists to guide frequency of measuring anti-HBs in HIV-HBV-coinfected persons following vaccine response, once yearly evaluation has been suggested for patients who have an ongoing risk for HBV acquisition (CIII), as recommended for dialysis patients
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