All patients presenting for PEP should be assessed for HBV (see Table 4).
- Individuals with evidence of previous immunity to HBV (HBsAb ≥ 10 IU ever documented following complete vaccination course, or past cleared infection who are immunocompetent) require no further follow-up
- Non-immune people (anti-HBc and HBsAb and negative) require HBV immunisation and follow-up (to six months)
- If the person is non-immune (HBsAb and HBcAb negative) and the source is known to have chronic HBV (HBsAg positive), follow Australian Immunisation Handbook guidelines.
HBV-positive (HBsAg-positive) people
- People known to have or newly diagnosed with HBV infection on baseline testing can be safely commenced on HIV PEP
- Refer to ASHM Decision Making in Hepatitis B tool.
- As soon as possible after chronic HBV is identified, collect additional blood for:
- HBeAg and anti-HBe
- HBV DNA (quantitative)
- Full blood count
- Liver function test (LFT), international normalised ratio (INR) test and alpha fetoprotein (AFP) tumour marker test
- Refer to a clinician experienced in managing HBV as soon as possible (and before completion of the 28-day HIV PEP course) for a decision about treatment discontinuation and follow-up.