This includes the utility of laboratory investigations and management strategies for patients with HIV who develop acute HBV infection, as well as those with chronic HBV/HIV infection with CD4 cell counts both above and below the threshold where ART is recommended for treatment of HIV alone. For the assessment and evaluation of evidence, priority questions were agreed and outcomes were ranked (critical, important and not important)

by members of the Writing Group. Three key questions were identified by the Writing Group. For deciding on when is the optimum Buparlisib supplier time to commence ART in adults with chronic HBV/HIV infection, the following were ranked as critical outcomes: mortality, HBV disease progression (cirrhosis, HCC), response to ART (HIV viral load <50 copies/mL, CD4

cell count increase), and severe treatment-associated adverse events. For deciding on which is the anti-HBV treatment of choice when the CD4 count is selleck kinase inhibitor >500 cells/μL, the following were regarded as critical outcomes: mortality, HIV disease progression, HBV disease progression (cirrhosis, HCC), HBV DNA decline on therapy, severe treatment-associated adverse events and patient acceptability. For deciding whether FTC or 3TC should be used in combination with tenofovir, the following were regarded as critical outcomes: HBV DNA decline on therapy, cost and adverse events. Treatments were compared where data were available and differences in outcomes assessed. Details of the search strategy and literature review are contained in Appendix 2. There are approximately 240 million individuals with HBsAg-positive hepatitis B (HBV) infection globally compared to an estimated 33.1 million with HIV infection [1]. The prevalence of HBV is related to patient characteristics, with the shared global endemicity and risks for transmission of both HIV and HBV resulting in a high prevalence of coinfection. An estimated 6.9% of adults with HIV infection in the UK have evidence of HBsAg positivity, 4��8C with those of Black or other ethnicity and those with a history of injection drug use (IDU) having the highest prevalence. In some European cohorts the overall prevalence

is slightly higher. Incidence of new HBV infection in patients with HIV infection is estimated at 1.7 cases per 100 years of follow-up in the UK [2]. In the HIV non-infected, chronic HBV infection is classified into different stages, which are not necessarily sequential (see Box 6.1 and Table 6.1). These distinguish between the level of viral replication and the extent of immunopathology. Whilst the validity of such classifications is not well established in HBV/HIV infection, these distinctions are helpful in framing an understanding of coinfection. Type Description 1 Immune tolerant: HBsAg positive, HBeAg positive, high HBV DNA, normal ALT/AST, little or no necro-inflammation on liver biopsy and no or slow progression of fibrosis.