Initiating Treatment in Patients with Hepatitis B and HIV Coinfection

You answered:

C Antiretroviral therapy for HIV is indicated, but antiviral therapy for HBV is not indicated because of the normal ALT. The antiretroviral combination should exclude tenofovir, emtricitabine, and lamivudine, since each of these antiretroviral medications also has activity against HBV.

This answer is incorrect. A normal ALT does not exclude the possibility of significant disease (fibrosis or inflammation) in HBV-HIV coinfected patients and would not preclude treatment of HBV. Regardless, once treatment for HIV is initiated, the regimen should have full activity against HBV.

Choose another answer:

A The patient should undergo a liver biopsy to determine if the HBV should be treated along with treatment for HIV infection.
B The patient should be started on a highly active antiretroviral therapy regimen that also will effectively treat hepatitis B.
D Peginterferon alfa would be considered first-line therapy for this patient's HBV infection given his HBeAg positive status.

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