A 28-year-old woman is newly diagnosed with HIV (CD4 380 cells/μL, viral load 55,000 copies/mL). She is HBsAg-positive. Which antiretroviral regimen is preferred, accounting for her hepatitis B coinfection?
- A Efavirenz + lamivudine + zidovudine
- B Bictegravir/tenofovir alafenamide/emtricitabine (B/F/TAF) ✓
- C Ritonavir-boosted lopinavir + lamivudine
- D Dolutegravir + abacavir + lamivudine (DTG/ABC/3TC) after HLA-B*57:01 testing
Correct answer: B. Bictegravir/tenofovir alafenamide/emtricitabine (B/F/TAF)
Explanation
In HIV/HBV coinfection, the ART regimen must contain two agents active against HBV — tenofovir (TDF or TAF) plus emtricitabine (FTC) or lamivudine (3TC). TAF-based regimens are preferred over TDF-based due to superior bone and renal safety profile. B/F/TAF (bictegravir/TAF/FTC) is a single-tablet regimen that covers both HIV and HBV and is currently preferred per DHHS 2023 and WHO 2021 guidelines. Abacavir-containing regimens are not active against HBV and require HLA-B*57:01 testing, making TAF-based regimens superior in this setting.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.