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HIV/HBV Coinfection ART — RACP Adult Medicine MCQ

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HardInfectious DiseasesHIV/HBV Coinfection ARTRACP Adult Medicine

A 30-year-old man presents with a new diagnosis of HIV (CD4 350 cells/μL, viral load 85,000 copies/mL). He has no opportunistic infections and is HLA-B*5701 negative. Hepatitis B surface antigen is positive (HBV DNA 15,000 IU/mL). What is the most appropriate initial antiretroviral regimen?

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Correct answer: B — Tenofovir DF/emtricitabine + dolutegravir

HIV/HBV coinfection requires an ART backbone containing tenofovir plus emtricitabine (or lamivudine), as both have dual activity against HIV and HBV. Tenofovir disoproxil fumarate (DF) is preferred over TAF for HBV coinfection due to more robust HBV data. Dolutegravir is a preferred INSTI. Abacavir/lamivudine cannot be used as it lacks HBV activity (risk of HBV flare if tenofovir is omitted).

Reference: ASHM – 2024 – HIV Guidelines; EACS 2024; DHHS 2025