Recommendations Monthly HBV DNA monitoring should be performed for patients undergoing hematopoietic stem cell transplantation or chemotherapy including rituximab, corticosteroids or fludarabine, during treatment and for at least 12 months after its completion. HBV DNA monitoring should be performed every 1–3 months for patients undergoing chemotherapy for hematological malignancies, not including rituximab, and standard chemotherapy for solid malignancies, although the monitoring duration and intervals can be adjusted in accordance HM781-36B order with the nature of the treatment. Monthly HBV DNA monitoring

should be performed at monthly intervals for patients undergoing immunosuppressive therapy for rheumatic or connective tissue diseases, for at least 6 months after commencement or alteration of treatment. After 6 months, the monitoring duration and intervals should be decided in accordance with the nature

of the treatment. If HBV reactivation occurs during chemotherapy or immunosuppressive therapy, it is preferable to consult with a hepatologist, and not immediately cease the anti-neoplastic agent with immunosuppressive activity or immunosuppressant agent. As we saw above in the section on acute HBV, coinfection with HBV and HIV infection may occur. HIV patients exhibit an HBsAg positive rate of 6.3%[358] and anti-HBs antibody positive rate of around 60%.[359] It has been reported that immunopathy associated Everolimus research buy with HIV can increase the likelihood of HBV infection becoming chronic by as much as 23%.[360] Over 80% of HBsAg positive Japanese HIV-infected patients have HBV genotype A[361], which contributes to the higher HBsAg positive rates among HIV sufferers. Thus, coinfection with HIV can occur in patients with chronic hepatitis B as well as those with acute hepatitis B. NAs

are the mainstay of HBV therapy in patients coinfected with HIV. Antiretroviral Dynein therapy (ART) for HIV infection involves a combination of three or more anti-HIV agents. Table 16 shows anti-HIV agents that are also active against HBV. Nucleoside analog reverse transcriptase inhibitors (NRTI) are generally used as two of the anti-HIV agents. They will normally have anti-HBV activity as well, to discourage the development of drug-resistant HBV. Reduce dosage for renal failure Different dosage to Zefix Reduce dosage for renal failure Contraindicated if hemoglobin <7.5 g/dL Contraindicated in combination with ibuprofen Reduced dosage for renal failure Contraindicated in severe hepatic dysfunction In patients with very low CD4 counts (well below the normal range of 800–1200/μL), ART may cause exacerbation of hepatitis due to recovery of cellular immunity, in a phenomenon known as Immune Reconstitution Inflammatory Syndrome (IRIS). In the majority of cases, IRIS is observed within 16 weeks of starting ART. It can be difficult to distinguish between IRIS and drug-induced liver injury.