Fatal Interruption of a 3TC-containing Regimen in a HIV-infected Patient Due to Re-activation of Chronic Hepatitis B Virus Infection

Do HIV Care Providers Appropriately Manage Hepatitis B in Coinfected Patients Treated with Antiretroviral Therapy?

“…As HIV-infected patients live longer as a result of antiretroviral therapy (ART), HBV infection has increasingly gained importance as a cause of death in such patients [2][3][4][5]. When patients receive drugs with dual activity (e.g., lamivudine, tenofovir disoproxil fumarate, and emtricitabine), they may experience acute flares of hepatitis resulting from immune reconstitution, drug withdrawal, the development of HBV drugresistance mutations, or all 3 causes [6][7][8][9][10][11][12]. The increased risk of hepatocellular carcinoma (HCC) [13] and the emergence of HBV drug-resistant mutations necessitates careful monitoring of coinfected patients after antiviral therapy is begun.…”

Virological rebound and its consequences during treatment interruption

“…Special attention should also be paid to patients coinfected with hepatitis B virus. If hepatitis B treatment with lamivudine, emtricitabine or tenofovir is interrupted, life-threatening hepatitis B virus rebound can result in fulminant hepatitis [53].…”

HIV in the Intensive Care Unit

“…When HAART is discontinued, all components should be discontinued simultaneously, since mono-or bitherapy may favor the development of resistance. On the other hand, patients with hepatitis B coinfection who are receiving emtricitabine, lamivudine or tenofovir, which have antihepatitis B activity, may develop an exacerbation of hepatitis when these drugs are stopped [66]. On one hand, non-nucleoside reverse transcriptase inhibitors (NNRTI) (efavirenz or nevirapine) have a long half-life with detectable plasma levels up to 21 days or more after discontinuation.…”