Complex situations Co-infection and Immunosuppression


KEY POINTS

  • Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) and hepatitis C and D viruses (HCV and HDV) results in worse outcomes for patients in terms of all-cause mortality, liver disease and hepatocellular carcinoma (HCC).
  • All individuals with chronic hepatitis B (CHB) should be tested for co-infection following appropriate pre-test discussion.
  • People with ongoing risk factors for co-infection should be offered repeat testing, particularly in the setting of clinical deterioration.
  • People with HCV co-infection should be offered treatment with direct-acting antiviral (DAA) therapy and the need for HBV treatment reassessed before commencing HCV therapy. If not on antiviral therapy for HBV, additional monitoring during DAA therapy may be required.
  • The approach to treatment for patients with co-infection is more complex than in the setting of mono-infection, and can be associated with increased risk of adverse outcomes.
  • All patients undergoing significant immune suppression should be tested for HBV infection as viral reactivation and associated flares of hepatitis can occur, which can be fatal.

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