Mid 20's MSM contacted us to start PrEP. Initial lab panel: negative for HIV, but has chronic hepatitis B (he was unaware), with eAg negative dz, low viral load at 328 IU/mL, mildly elevated ALT only at 77. No liver imaging yet. From social history we have reason to think he acquired it at birth.
Questions and concerns:
Thanks in advance,
Josh Rohr PA-C, AAHIVS
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Hi Joshuai would start him on PrEP because he is at high risk for contracting HIV. I would advise him that since TAF/FTC or TDF/FTC will suppress his HBV, the most important thing is if he decides to discontinue PrEP, he is at risk for an HBV flare, so would need LFTs checked monthly for a few months after stopping. You are correct that based on HBV guidelines, with very low HBV DNA and mildly elevated LFTs, he would not otherwise be started on HBV treatment, but that his PrEP treatment will suppress his HBV. Given his already low DNA I'm not sure that he has much risk of transmitting HBV anyway, but others can weigh in on that. He should be counseled re HCV risk and screened periodically for that. If he is not HAV immune he should be vaccinated.