Complex situations Co-infection and Immunosuppression

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  • 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

GESA Consensus Recommendation 31

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