- 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.
See: Hepatitis B management during immunosuppression for haematological and solid-organ malignancies: An Australian consensus statement 2019
Click to open GESA recommendations
GESA Consensus Recommendation 25
GESA Consensus Recommendation 26
GESA Consensus Recommendation 27
GESA Consensus Recommendation 28
GESA Consensus Recommendation 29
GESA Consensus Recommendation 30
- European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017;67:370-98.
- Terrault N, Bzowej N, Chang K, Hwang JP, Jonas MM, Murad MH; American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016;63:261-83.
- Cowie BC, Dore G, Sasadeusz J, editors. Co-infection: HIV and viral hepatitis - a guide for clinical management. 4th ed. Darlinghurst: Australasian Society for HIV Medicine; 2010.
- The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2017. Sydney: The Kirby Institute, The University of New South Wales; 2017.
- Body A, Hoy JF, Cheng AC, Giles ML. Incident hepatitis B virus (HBV) infection subsequent to the diagnosis of HIV infection in a Melbourne cohort; missed opportunities for prevention. Sex Health 2014;11:5-10.
- Gamagedara N, Weerakoon AP, Zou H, Fehler G, Chen MY, Read TR, et al. Cross-sectional study of hepatitis B immunity in MSM between 2002 and 2012. Sex Transm Infect 2014;90:41-5.
- Allard N, Cowie B. Hepatitis B in men who have sex with men and HIV-infected individuals: missed opportunities and future challenges. Sex Health 2014;11:1-4.
- Australian Government. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook 10th ed. (2017 update). Canberra: Australian Government Department of Health; 2017.
- Shukla NB, Poles MA. Hepatitis B virus infection: co-infection with hepatitis C virus, hepatitis D virus, and human immunodeficiency virus. Clin Liver Dis 2004;8:445-60, viii.
- Thio CL, Locarnini S. Treatment of HIV/HBV coinfection: clinical and virologic issues. AIDS Rev 2007;9:40-53.
- Thio CL. Hepatitis B and human immunodeficiency virus coinfection. Hepatology 2009;49(5 Suppl):S138-45.
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Antiretroviral Guidelines. US DHHS Guidelines with Australian commentary [internet]. Available at: http://arv.ashm.org.au(last accessed 2 July 2018).
- Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-36.
- Amin J, Dore GJ, O'Connell DL, Bartlett M, Tracey E, Kaldor JM, et al. Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study. J Hepatol 2006;45:197-203.
- Amin J, Law MG, Bartlett M, Kaldor JM, Dore GJ. Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study. Lancet 2006;368:938-45.
- Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (August 2017). Melbourne: Gastroenterological Society of Australia; 2017. Available at: http://cart.gesa.org.au/membes/files/Resources/Hepatitis%20C/hepatitis_C_virus_infection_consensus_statement_Aug_2017.pdf(last accessed 3 July 2018).
- Hughes SA, Wedemeyer H, Harrison PM. Hepatitis delta virus. Lancet 2011;378:73-85.
- Shadur B, Maclachlan J, Cowie B. Hepatitis D Virus in Victoria 2000-2009. Intern Med 2013;43:1081-7.
- Davies J, Tong SYC, Davis JS. Hepatitis D is rare or non-existent in hepatitis B virus-infected Indigenous Australians in the Northern Territory. Aust NZ J Public Health 2013;37:188-9.
- Wedemeyer H. Re-emerging interest in hepatitis delta: new insights into the dynamic interplay between HBV and HDV. J Hepatol 2010;52:627-9.
- Bazinet M, Pantea V, Cebotarescu V, Cojuhari L, Jimbei P, Albrecht J, et al. Safety and efficacy of REP 2139 and pegylated interferon alfa-2a for treatment-naive patients with chronic hepatitis B virus and hepatitis D virus co-infection (REP 301 and REP 301-LTF): a non-randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol 2017;2:877-89.
- MacLachlan J, Allard N, Carville K, Haynes K, Cowie B. Mapping progress in chronic hepatitis B: geographic variation in prevalence, diagnosis, monitoring and treatment, 2013-15. AustNZ J Public Health 2018;42:62-8.
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). National HBV Testing Policy [internet]. Available at: http://testingportal.ashm.org.au/hbv(last accessed 2 July 2018).
- Tsutsumi Y, Ogasawara R, Miyashita N, Tanaka J, Asaka M, Imamura M. HBV reactivation in malignant lymphoma patients treated with rituximab and bendamustine. Int J Hematol. 2012;95:588-91.
- Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with haematological malignancies. Br J Haematol 2007;136:699-712.
- Lopez-Serrano P, de la Fuente Briongos E, Alonso EC, Perez-Calle JL, Rodriguez CF. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: when and how to apply prophylaxis, with a special focus on corticosteroid therapy. World J Hepatol 2015;7:539-47.