Tenofovir Alafenamide for Chronic Hepatitis B with HIV Co-infection

Medical Necessity Assessment

• The American Association for the Study of Liver Diseases and European Association for the Study of the Liver recommend that all HBV/HIV co-infected patients should be assessed to determine if there is an indication for either HIV or HBV treatment, or both 1, 4
• Patients with chronic hepatitis B and detectable viral load require treatment, as HIV co-infection accelerates liver disease progression and increases risk of cirrhosis and hepatocellular carcinoma 3, 5, 6

Appropriate Medication Selection

• The European Association for the Study of the Liver recommends that treatment for HBV/HIV co-infected patients should include agents active against both viruses to prevent development of resistance 2, 7, 8
• Tenofovir-based regimens are specifically recommended as first-line therapy for HBV/HIV co-infection by the American Association for the Study of Liver Diseases and European Association for the Study of the Liver 1, 2, 3

Standard of Care Evaluation

• According to the European Association for the Study of the Liver guidelines, HIV-positive patients with chronic HBV should receive treatment with tenofovir combined with emtricitabine or lamivudine plus appropriate HIV therapy 3
• The World Health Organization recommends that co-infected patients with an indication for treatment of either HBV and/or HIV should receive a triple combination of antiretroviral agents, including two that are active against HBV 1, 4

Monitoring and Safety Considerations

• The American Association for the Study of Liver Diseases recommends monitoring HBV DNA levels every 12-24 weeks and liver function tests every 12 weeks in patients treated with TAF 5