A patient co-infected with HIV and Hepatitis B virus (HBV) is being started on antiretroviral therapy (ART). Which antiretroviral agent should be included in the regimen because it is also active against HBV?

• A Efavirenz
• B Raltegravir
• C Darunavir
• D Tenofovir disoproxil fumarate (TDF) ✓

Explanation

Tenofovir (TDF or TAF) is a nucleotide reverse transcriptase inhibitor (NRTI) active against both HIV and HBV. It is a potent HBV DNA polymerase inhibitor and is first-line treatment in HBV/HIV co-infected patients; all WHO-recommended first-line ART regimens for HIV/HBV co-infection include TDF + lamivudine or emtricitabine (both also active against HBV). Efavirenz is an NNRTI with no HBV activity. Raltegravir (integrase inhibitor) and darunavir (protease inhibitor) have no HBV activity.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

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