Hence, HAART incorporating agents active against HBV (tenofovir and emtricitabine) should be continued in this group. In those women with CD4 cell counts of >500 cells/μL with a baseline HBV DNA >2000 IU/mL and/or evidence of fibrosis on biopsy or FK228 Fibroscan, HBV treatment should be continued because of the risk of progressive liver disease if discontinued. In these patients, HAART incorporating tenofovir and emtricitabine
should be continued. Adefovir is an option and has been evaluated against HBV in coinfected patients. It does not select resistance against tenofovir but is less active than tenofovir. Neither entecavir (has antiviral activity to HIV and selects resistance) nor telbivudine (high resistance rates) are suitable Ruxolitinib molecular weight in coinfection. In those with CD4 cell counts over 500 cells/μL who received HAART to prevent MTCT and who are not HBV viraemic (>2000 IU/mL) or have evidence of established liver disease, strong consideration should be given to continuing anti-HBV therapy, in the form of tenofovir-based HAART because of the risk of progression of liver disease in coinfection. Inflammatory flares, which may be severe, particularly in persons with cirrhosis can occur because of viral escape and HBV viraemia, if anti-HBV drugs are stopped. In an RCT comparing lamivudine with placebo for reducing HBV MTCT
in patients with HBV mono-infection, an immediate increase in HBV DNA levels was observed on discontinuation of lamivudine postpartum [15]. Similarly, hepatitis flares among HIV/HBV coinfected patients have been reported upon the discontinuation of lamivudine,
emtricitabine and tenofovir. In the Swiss HIV observational cohort, liver enzyme elevation occurred in 29% of patients who discontinued lamivudine and in 5% this was severe, with three patients presenting with fulminant hepatitis [16] at a median time of 6 weeks after discontinuation. Hepatitis flares that occurred after ART cessation should be treated by resumption of active anti-HBV treatment before significant liver failure occurs. 6.1.17 Mannose-binding protein-associated serine protease In the absence of obstetric complications, normal vaginal delivery can be recommended if the mother has fully suppressed HIV VL on HAART. Grading: 2C No data exist to support any benefit from PLCS in mothers with HBV/HIV coinfection and no robust RCT exists in HBV mono-infected women. In a meta-analysis of mono-infected HBV women (four randomized trials all from China involving 789 people were included) where routine HBV neonatal vaccine and HBIG were used, there was strong evidence that PLCS vs. vaginal delivery could effectively reduce the rate of MTCT of HBV (RR 0.41; 95% CI 0.28–0.60) [17]. However, methodological concerns, including lack of information on randomization procedure, lack of allocation concealment and lack of blinding make the role of PLCS for PMTCT of HBV uncertain.