A 30-year-old HIV-positive patient (CD4 count 180 cells/μL, viral load 45,000 copies/mL) is about to start ART. He is coinfected with hepatitis B virus (HBsAg positive, HBV DNA 8 × 10⁵ IU/mL). The MOST appropriate ART regimen is:

• A Efavirenz + lamivudine + tenofovir disoproxil fumarate (TDF)
• B Dolutegravir + tenofovir alafenamide (TAF) + emtricitabine (FTC) — all three agents active against HBV ✓
• C Zidovudine + abacavir + dolutegravir — to avoid nephrotoxicity of tenofovir
• D Start ART after completing 6 months of entecavir for HBV suppression

Explanation

In HIV/HBV coinfection, ART must include two anti-HBV active nucleos(t)ides. Tenofovir (TDF or TAF) + emtricitabine (FTC) covers both HIV and HBV. Dolutegravir is the preferred INSTI backbone (WHO preferred first-line). TAF has less nephrotoxicity and bone loss than TDF. Emtricitabine (FTC) also has anti-HBV activity. Lamivudine alone carries a high risk of selecting HBV resistance. Regimens without tenofovir are insufficient for HBV. Starting ART is never delayed in coinfection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.