Lamivudine

has been extensively used, as has tenofovir and to a lesser extent emtricitabine, for the treatment of HIV mono-infection during pregnancy, and lamivudine and telbivudine have been used in HBV mono-infected pregnant women and all have been buy LDE225 found to be safe. There are limited data on adefovir use in pregnancy and it is not recommended. Where it is being used in a woman for management of HBV but who does not require HIV treatment, this should be switched to tenofovir incorporated into her HAART regimen. In the context of coinfection during pregnancy where HAART is indicated, there is unlikely to be a situation where it would be used instead of tenofovir. There is no evidence of any adverse effect on maternal health if women become pregnant while taking tenofovir, lamivudine or emtricitabine: these drugs are recommended as NRTI choices in national [10] and international guidelines [2]. 6.1.6 In all HAV non-immune HBV coinfected women, HAV vaccine is recommended after the first trimester as per the normal schedule (0 and 6–12 months) unless the CD4

cell count is <300 cells/μL, when an additional dose may be indicated. Grading: 1D Immunization for HAV uses inactivated vaccines. Data for HAV vaccine in pregnancy are limited. Nevertheless, several guidelines indicate that pregnancy is not a contraindication for HAV immunization, including in HBV coinfected pregnant women [[11],[12]]. 4-Aminobutyrate aminotransferase For HAV vaccines, patients with higher CD4 cell counts and on HAART generally show improved responses to find more vaccination. HIV-positive persons with CD4 cell counts <300 cells/μL should receive three doses of HAV vaccine over 6–12 months instead of the standard two. 6.1.7 Tenofovir and emtricitabine should form the backbone of an ART regimen in naïve patients with wild-type HIV/HBV infection and no contraindication to either drug (Grading: 1B). 6.1.8 If tenofovir is not

currently part of HAART it should be added. Grading: 1B 6.1.9 Lamivudine/emtricitabine may be omitted from the ARV regimen and tenofovir given as the sole anti-HBV agent if there is clinical or genotypic evidence of lamivudine/emtricitabine resistant HBV. Grading: 1C 6.1.10 Lamivudine or emtricitabine should not be used as the only active drug against HBV in HAART because of the likelihood of emergent HBV resistance to these agents. Grading: 1B 6.1.11 Emtricitabine has potential antiviral benefits over lamivudine, is coformulated with tenofovir, and appears to be equally safe during pregnancy and hence is the preferred option to be given with tenofovir in coinfection. Grading: 2D All HBV/HIV coinfected women should receive HAART containing tenofovir with emtricitabine or lamivudine treatment during pregnancy, unless contraindicated.