1.2 We recommend EFV in combination with TDF and FTC as first-line ART in TB/HIV coinfection. 1C We recommend that when rifampicin is used with EFV in patients over 60 kg, the EFV dose is increased to 800 mg daily. Standard Etoposide doses of EFV are recommended
if the patient weighs <60 kg. 1C We recommend that rifampicin is not used with either NVP or a PI/r. 1C We recommend that where effective ART necessitates the use of PI/r that rifabutin is used instead of rifampicin. 1C CD4 cell count (cells/μL) HBV requiring treatmenta HBV not requiring treatment HCV with immediate plan to start HCV treatmenta HCV with no immediate plan to start HCV treatment a See BHIVA Guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus [1] for indications Selleck 5FU to treat hepatitis B and C. Start ART in some patients (2C) (Include TDF and FTC) Start ART (1B) (Include TDF and FTC) Start ART (1B) (Include TDF and FTC) 350–500 Start ART after HCV treatment commenced (1C) <350 Start ART before HCV treatment (1B) Discuss with HIV and viral hepatitis specialist 8.2.2.1 ● We
recommend patients with HIV and hepatitis B virus coinfection who have a CD4 cell count <500 cells/μL are treated with fully suppressive ART inclusive of anti-HBV active antivirals. 1B ● We recommend patients with HIV and HBV coinfection who have a CD4 cell count ≥500 cells/μL and who have an HBV-DNA ≥2000 IU/mL and/or evidence of more than minimal fibrosis (Metavir ≥F2) are treated with fully suppressive ART inclusive of anti-HBV active antivirals. 1C 8.2.2.2 ● We recommend
TDF/FTC as part of a fully suppressive ART combination should be given to all patients where HBV treatment is deemed necessary. 1C ● We recommend neither 3TC nor FTC be used as the sole active drug against HBV in ART due to the rapid emergence of HBV resistant to these agents. 1B ● We recommend 3TC/FTC may be omitted from the ART regimen and tenofovir be given nearly as the sole anti-HBV active agent if there is clinical or genotypic evidence of 3TC/FTC-resistant HBV or HIV. 1D 8.2.3.1 ● We recommend all patients with HIV and hepatitis C virus coinfection be assessed for HCV treatment. GPP ● We suggest commencing ART when the CD4 cell count is greater than 500 cells/μL in all patients who are not to commence HCV treatment immediately. 2D ● We recommend commencing ART when the CD4 cell count is less than 500 cells/μL in all patients who are not to commence anti-HCV treatment immediately. 1B ● We recommend commencing ART to optimize immune status before anti-HCV therapy is initiated when the CD4 cell count is between 350 and 500 cells/μL unless there is an urgent indication for anti-HCV treatment when ART should be commenced as soon as the patient has been stabilized on HCV therapy.