At

least half the people living with HIV have serum markers of previous hepatitis B virus (HBV) infection [56]. Occult hepatitis B, in which there is viral replication in JQ1 cell line the absence of surface antigen, is well documented in HIV-positive patients [57,58]. Reactivation of HBV and a rise in HBV DNA can occur at low CD4 cell counts, and has been documented in both HIV-positive and HIV-negative patients receiving immunosuppressive chemotherapy [59–66]. In one study of HBV surface antigen, of the HIV-positive patients treated with chemotherapy for lymphoma who did not receive antiviral prophylaxis, 32% experienced HBV reactivation of whom 41% progressed to fatal fulminant hepatitis [67]. The risk of HBV reactivation appears to be particularly high in patients treated with rituximab containing chemotherapy regimens [68]. Vemurafenib purchase The use of prophylactic lamivudine in people at risk of HBV reactivation who were treated for lymphoma with chemotherapy reduces the incidence of HBV reactivation, severe hepatitis and the disruptions to chemotherapy compared to historical controls [69]. A meta-analysis of 14 studies involving a total of 275 at-risk patients receiving chemotherapy who were treated with prophylactic lamivudine showed that it reduced the risk of HBV reactivation

and HBV-related hepatitis by 80–100% [70]. Patients with antibodies against hepatitis B core antigen (HBcAb) should be treated with prophylactic antivirals in line with BHIVA hepatitis guidelines (level of evidence 1B) [71] and this should be continued for at least 6 months after completion of anticancer therapy [72]. People living with HIV and malignancies should receive immunizations in line with the BHIVA immunization guidelines [55] and those who have had a splenectomy should receive vaccinations and antibiotic prophylaxis in line with national asplenism

guidelines [73]. We recommend that all patients with AIDS-defining malignancies should start HAART (level of evidence 1B). We suggest that all patients with non-AIDS-defining malignancies who are due to start chemotherapy or radiotherapy should be started on HAART unless contraindicated (level of evidence 2C). We recommend that prophylaxis against Pneumocystis jirovecii pneumonia (PCP) should be started Docetaxel in vivo for those who have a CD4 cell count less than 200 cells/μL (level of evidence 1A) and should be considered at higher levels in all patients starting chemotherapy or radiotherapy (GPP). We recommend prophylaxis against MAC for individuals with a CD4 cell count less than 50 cells/μL (level of evidence 1B) and in those whose treatment puts their CD4 count at risk of falling below this level. We recommend that systemic azole antifungal prophylaxis should be used in all patients receiving chemotherapy or radiotherapy for HIV-associated malignancy (level of evidence 1D).