The decision to initiate treatment for either HIV or viral hepatitis infections should ordinarily be made with agreement of the patient’s HIV and viral hepatitis physicians. In patients with cirrhosis (Child–Pugh grade B/C) certain ART should be used with caution and careful monitoring ABT-199 purchase (including TDM) will be required by physicians experienced in the management of HIV and viral hepatitis coinfection. For further information on use of ART in patients with cirrhosis please refer to the BHIVA guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus [1]. 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 to treat hepatitis B and C. 350–500 cells/μL: Start ART after HCV treatment commenced (1C) <350 cells/μL: Start ART before HCV treatment (1B) Discuss

with HIV and viral hepatitis specialist We recommend patients with HIV and HBV coinfection who have a CD4 cell count between 350 and 500 cells/μL start ART (1C). We suggest patients with HIV and HBV coinfection who have a CD4 cell count >500 cells/μL and who require treatment for their hepatitis B start ART (2C). Proportion of patients with HIV and HBV coinfection with MDV3100 CD4 cell counts <500 cells/μL on ART. Because of the negative effect of immune depletion on HBV disease progression, the availability of single drugs with high-level dual hepatitis B and HIV antiviral activity, and the increased risk of liver-related deaths in patients with CD4 cell counts below

500 cells/μL, co-infected patients with CD4 cell counts between 350 and 500 cells/μL should start ART and be treated with drugs active at suppressing both viruses [2]. Consideration can be given to some patients with CD4 cell counts between 350 and 500 cells/μL and HBV DNA of <2000 IU/L and no evidence of liver Aspartate inflammation or fibrosis to close monitoring of their HIV and hepatitis B infections as an acceptable alternative strategy. Individuals with a CD4 cell count >500 cells/μL who do not require hepatitis B therapy, should be monitored for HIV and hepatitis B disease progression and the need of therapy for either virus infection. Among individuals with a CD4 cell count >500 cells/μL who require treatment for hepatitis B infection there is the option to start ART with drugs active at suppressing both viruses. For indications to start treatment for hepatitis B infection, please refer to BHIVA guidelines on management of coinfection with HIV and hepatitis B or C virus [1]. We recommend patients with HIV and HBV coinfection who start ART include TDF and FTC as part of their ART regimen, if there are no contraindications for either drug (1A).