BHIVA guidelines on HIV and chronic hepatitis: coinfection with HIV and hepatitis C virus infection (2005).

(1) All HIV-positive patients should have serum markers for hepatitis B checked (HBsAg, anti-HBc and/or antiHBs) tests within a month of diagnosis [II]. (2) All those negative for hepatitis B markers should be immunized and anti-HBs checked at 12 weeks. Patients failing to respond to a conventional course of 20 mg vaccine should received booster doses and/or a repeat vaccination cycle with the 40 mg dose. Response to vaccine may be reduced if the CD4 count is less than 500 cells/mm [I]. (3) Those patients with a CD4 counto200 cells/mm not on ART should receive combination therapy first and with immune recovery, subsequent immunization. (4) Following successful immunization, anti-HB levels should be checked yearly and booster doses of vaccine should be given to those with an anti-HB levelo100 im/ L [IV]. (5) Persons who fail to seroconvert to HBV vaccine and are at continuing risk of HBV infection should have annual HBV markers performed (HBsAg and anti-HBc) [IV]. (6) All patients who are anti-HBc positive but HBsAg negative are at risk of HBV reactivation. HBV markers including HBV-DNA should be rechecked annually or if the liver function tests (AST/ALT) become abnormal [II]. (7) All HIV-infected persons should have serum markers for HBV checked before antiretroviral (ARV) therapy is commenced and then reassessed at least once a year. Decisions on appropriate ART combinations can then be made [IV].