[Table, Assessment Before HBV Treatment]. - Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

RECOMMENDATIONS
Liver Disease Assessment Before initiating HBV treatment in patients with HIV, clinicians should obtain a complete physical examination and medical history, including the use of hepatoxic medications (A); noninvasive fibrosis evaluation (A2†); baseline ultrasonography for HCC [a] (A2†); and the following laboratory testing: CBC, albumin, bilirubin, alkaline phosphatase, PT/INR, ALT, AST, and a basic metabolic panel. (A) Clinicians should refer patients with HIV/HBV coinfection and cirrhosis to a gastroenterologist or hepatologist to assess and manage complications of portal hypertension. (A3) In patients with HIV/HBV coinfection and cirrhosis, clinicians should screen for HCC with ultrasound every 6 months. (A2†) See the guideline section HBV Treatment and Monitoring > Ongoing Screening for Hepatocellular Carcinoma regarding screening for patients without cirrhosis. Alcohol Use Screening and Education Clinicians should perform alcohol use screening in patients with HIV/HBV coinfection at baseline and at least annually and refer patients for treatment as needed. (A3) See the NYSDOH AI guidelines Substance Use Screening and Risk Assessment in Adults and Treatment of Alcohol Use Disorder. Clinicians should educate patients about the detrimental effects of alcohol use on the course of HBV infection and counsel patients with underlying liver disease to abstain from or minimize alcohol use. (A) HAV, HCV, and HDV Status* Clinicians should perform anti-HAV IgG or total (IgM and IgG) serum testing and administer the full HAV vaccine series in patients who are not immune to HAV. (A3) Clinicians should determine patients’ HCV status by medical history and serum testing and recommend treatment with DAA therapy if chronic HCV infection is diagnosed. (A1) See the NYSDOH AI guidelines Hepatitis C Virus Screening, Testing, and Diagnosis in Adults and Treatment of Chronic Hepatitis C Virus Infection in Adults. Clinicians should perform anti-HDV total (IgM and IgG) serum testing to screen for HDV in all patients with HIV/HBV coinfection. (B2)

RECOMMENDATIONS

Liver Disease Assessment

Before initiating HBV treatment in patients with HIV, clinicians should obtain a complete physical examination and medical history, including the use of hepatoxic medications (A*); noninvasive fibrosis evaluation (A2†); baseline ultrasonography for HCC [a] (A2†); and the following laboratory testing: CBC, albumin, bilirubin, alkaline phosphatase, PT/INR, ALT, AST, and a basic metabolic panel. (A*)
Clinicians should refer patients with HIV/HBV coinfection and cirrhosis to a gastroenterologist or hepatologist to assess and manage complications of portal hypertension. (A3)
In patients with HIV/HBV coinfection and cirrhosis, clinicians should screen for HCC with ultrasound every 6 months. (A2†)
- See the guideline section HBV Treatment and Monitoring > Ongoing Screening for Hepatocellular Carcinoma regarding screening for patients without cirrhosis.

Alcohol Use Screening and Education

Clinicians should perform alcohol use screening in patients with HIV/HBV coinfection at baseline and at least annually and refer patients for treatment as needed. (A3)
- See the NYSDOH AI guidelines Substance Use Screening and Risk Assessment in Adults and Treatment of Alcohol Use Disorder.
Clinicians should educate patients about the detrimental effects of alcohol use on the course of HBV infection and counsel patients with underlying liver disease to abstain from or minimize alcohol use. (A*)

HAV, HCV, and HDV Status

Clinicians should perform anti-HAV IgG or total (IgM and IgG) serum testing and administer the full HAV vaccine series in patients who are not immune to HAV. (A3)
Clinicians should determine patients’ HCV status by medical history and serum testing and recommend treatment with DAA therapy if chronic HCV infection is diagnosed. (A1)
- See the NYSDOH AI guidelines Hepatitis C Virus Screening, Testing, and Diagnosis in Adults and Treatment of Chronic Hepatitis C Virus Infection in Adults.
Clinicians should perform anti-HDV total (IgM and IgG) serum testing to screen for HDV in all patients with HIV/HBV coinfection. (B2)

From: Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

Cover of Prevention and Management of Hepatitis B Virus Infection in Adults With HIV

Prevention and Management of Hepatitis B Virus Infection in Adults With HIV [Internet].

Gupta A, Fine SM, Vail RM, et al.

Baltimore (MD): Johns Hopkins University; 2022 Aug.

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