Initial therapy for adults with HIV and hepatitis B virus co-infection

For HIV and hepatitis B virus co-infection, use a regimen containing emtricitabine plus tenofovir alafenamide or a tenofovir disoproxil salt. Seek expert advice for management of patients with HIV or hepatitis B strains that are resistant to these drugs, and patients in whom resistance is suspected due to previous antiviral therapy. INSTI-based single-tablet, once-daily combination products suitable for HIV and hepatitis B virus co-infection include1:

1tenofovir alafenamide+emtricitabine+bictegravir (Biktarvy) 25 mg+200 mg+50 mg orally, daily. For dosage adjustment in adults with kidney impairment, see tenofovir alafenamide+emtricitabine+bictegravir dosage adjustment. For practice points for initiation of therapy, see Practice points for initial antiretroviral therapy tenofovir alafenamide + emtricitabine + bictegravir (Biktarvy) tenofovir alafenamide+emtricitabine+bictegravir (Biktarvy) tenofovir alafenamide+emtricitabine+bictegravir (Biktarvy)

OR

1tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya) 10 mg+200 mg+150 mg+150 mg orally, daily. For dosage adjustment in adults with kidney impairment, see tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat dosage adjustment. For practice points for initiation of therapy, see Practice points for initial antiretroviral therapy. tenofovir alafenamide + emtricitabine + elvitegravir + cobicistat (Genvoya) tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya) tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya)

If these regimens are not suitable, any of the regimens containing emtricitabine plus tenofovir alafenamide can be used – see PI-based initial therapy in adults or NRTI+NNRTI-based initial therapy in adults. If the patient cannot take tenofovir alafenamide or a tenofovir disoproxil salt, do not use lamivudine or entecavir monotherapy to treat hepatitis B, because this can result in drug-resistant HIV. For further information on hepatitis B in patients with HIV infection, see Hepatitis B virus (HBV) infection in adults with HIV infection and seek expert advice.

Note: For patients with HIV and hepatitis B co-infection who cannot take tenofovir alafenamide or a tenofovir disoproxil salt, do not use lamivudine or entecavir monotherapy to treat hepatitis B.
1 Brand names are examples only; other brands may be available.Return