In the first series of experiments, we loaded the cells with the low-affinity Ca2+ dye, mag-fluo-4 (KD for Ca2+: 22 μM). It has been shown previously that this dye is preferentially trapped within the lumen of the ER, and, most important, its fluorescence-intensity changes GSK2126458 are proportional to the [Ca2+] within this organelle. 21 Figure 1 shows that, at rest, the fluorescence-signal intensity of WT cells is larger than that of Pkd2KO cholangiocytes, whereas addition of the SERCA inhibitor, thapsigargin (2 μM), in the absence of extracellular Ca2+, resulted in a drop of mag-fluo-4 signal in both control and Pkd2KO cells. However, the drop of mag-fluo-4 fluorescence

caused by thapsigargin was much faster and larger in controls, compared to Pkd2KO cholangiocytes. In a second series of experiments, we measured [Ca2+]c changes after administration of adenosine triphosphate (ATP; 10 μM) or ionomycin (5 μM) in cells loaded with fura-2 and incubated in a Ca2+-free buffer. With any other parameter being similar, differences in the [Ca2+]c peaks reflect differences in the amount of Ca2+ released from intracellular stores. 9, 10, 27 The amount of Ca2+ released from the ER by ATP, an inositol 1,4,5-triphosphate (IP3)-generating agonist, both when measured as peak [Ca2+]c

increase relative to baseline and as the area under the curve (AUC), was significantly reduced in Pkd2KO cholangiocytes (peak increase: 50.12 ± 14 nM; AUC: 16 ± 0.7 AU; n Obeticholic Acid price = 53) with respect to WT (peak increase: 214 ± 16 nM; AUC 38 ± 11 AU; n = 53; P < 0.001) (Fig. 2). Qualitatively similar results were obtained when Ca2+ was not specifically mobilized from the stores using the Ca2+ ionophore,

ionomycin (peak increase in Pkd2KO cells: 38.8 ± 6.5 nM; AUC: 12 ± 5.6 AU) with respect to WT (peak Orotidine 5′-phosphate decarboxylase increase: 219 ± 28 nM; AUC: 42 ± 13 AU; n = 48; P < 0.001). When ER Ca2+ levels are acutely decreased, SOCE is activated. The efficiency of Ca2+ entry resulting from SOC can be conveniently estimated by measuring [Ca2+]c changes upon the readdition of extracellular Ca2+ to cells whose stores have been depleted (in Ca2+-free medium) by thapsigargin or ionomycin. SOCE-dependent [Ca2+]c increase was significantly slower (and the peak smaller) in Pkd2KO cholangiocytes (thapsigargin: rate of [Ca2+]c rise = 3.53 ± 0.52 nM/sec in WT versus 0.38 ± 0.09 nM/sec in Pkd2KO cells; peak increase in WT and Pkd2KO: 135 ± 39 and 34 ± 17 nM [P < 0.001], respectively; ionomycin: rate of [Ca2+]c rise = 7.3 ± 0.31 nM/sec in WT versus 0.52 ± 0.069 nM/sec in Pkd2KO cells; peak increase in WT and Pkd2KO: 245 ± 49 and 30 ± 19 nM [P < 0.001], respectively) (Fig. 3). Western blotting analysis of STIM-1 and Orai expression showed no difference in expression of the main components of SOCE between WT and Pkd2KO cells (Supporting Fig.

We started training for beginners with the goal of the future expert training early in our hospital. We considered what kind of degree of achievement change was seen in a beginners of ERCP this time. Methods: Four hundred and fourty nine cases that six doctors, in 2 or 3 years carried out after graduation without experience of ERCP were performed in 676 cases on during 3 years from April 2009 to March 2013 in our hospital. We investigated the number of times before being able to achieve an aim as below.

1. Able to insert a lateral vision scope consecutive 3 times within5 minutes. 2. Able to pass a pylorus ring consecutive 3 times within 10 minutes. 3. Able to insert in a duodenal second portion consecutive 3 times within 10 minutes. 4. Able to linearize a scope consecutive 3 times within 10 minutes. 5. Able to observe a majar papilla in the front consecutive 3 times within JNK inhibitor libraries 10 minutes. 6. Able to start a cannulation consecutive 3 times within 10 minutes. 7. Able to succeed a cannulation consecutive Selleckchem ICG-001 twice within 15 minutes. When trainee could not achieve the above or when dangerous operation was seen on the way, we changed it to a specialist

in instruction promptly. Results: The median of experience number of each docter is 66 cases (39–115). The median numbers of times before achieving an aim are, insersion of sideviewer: 8 (6/6), pylorus ring passage: 11 (6/6), insertion to second portion of duodenum: 13 (6/6), linearization of the OSBPL9 scope: 19 (6/6), recognaize the papilla in front: 32 times (5/6), start to cannulation: 48 (4/6), successful cannulation: 80 times (2/6). Conclusion: We learned it until the linearization of the scope by an overall degree of achievement curve relatively easily, but it became clear that the technique acquisition suddenly became difficult from recognize the papilla

in front to successful cannulation. On this examination allowing the pickup of the common problems that or is different between each practiced hand, and examining a rational training method of the future. Key Word(s): 1. ERCP; 2. training; Presenting Author: NISA NETINATSUNTON Additional Authors: SIRIBOON ATTASARANYA, JAKSIN SOTISUNPORN, TEEPAWIT WITEERUNGROT, BANCHA OVARTLARNPORN Corresponding Author: NISA NETINATSUNTON Affiliations: NKC Institue of Gastroenterology and Hepatology; NKC Institiue of Gastroenterology and Hepatology Objective: Pancreatic duct stone (PDS) in chronic pancreatitis (CP) is a challenging condition for endoscopists. Endoscopic retrograde pancreatography (ERP) can clear PDS in only some CP patients and many centers combined ERP with extracorporeal shockwave lithotripsy (ESWL) to improve PDS clearance. There is no published data regarding ESWL and ERP in the management of PDS in Thailand available.

Liver function Tofacitinib and coagulation profile showed that the patients had liver failure. AFLP was diagnosed. Emergency lower segment caesarean section was performed and delivered two live babies. The umbilical cord blood of patients was collected immediately after delivery. Then UCBSC were isolated using Ficoll-Hypaque,

suspended in normal sodium, transfused into patients by intravenous. At the same time, cryopreserved allogeneic UC-MSC were recovered and proliferated. At postpartum 4 days, 8 days and 12 days, UC-MSC was suspended in normal sodium and transfused into patients by intravenous. Results: The hospitalization time of two patients was 40 days and 36 days respectively. The bilirubin and liver enzymes of

the patient started to decrease at post-treatment 14 days, and the liver function had returned to normal before when they discharged. The clinical evolution of maternal and child were favorable and no side effects were observed during the 1-year follow-up. Conclusion: These two cases PD-1/PD-L1 tumor indicate that USBSC and UC-MSC can be used in the treatment of AFLP. They may help to restore injured liver function in patients with AFLP. Key Word(s): 1. AFLP; 2. Umbilical Cord; 3. stem cells; Presenting Author: ZHU ZHITAI Corresponding Author: ZHU ZHITAI Affiliations: ying tan people’s hospital Objective: To explore the effect of probiotics in the treatment of patients with hepatic encephalopathy. Methods: 30 cases of patients with hepatic encephalopathy (excluding clinical IV stage), were randomly divided into treatment group and control group. Treatment group: routine liver

protection against hepatic coma therapy, oral or nasal feeding live bacillus cereus capsules (0.5/, 3 /d), Shea diabetes 10 ml/, 3 times /d; the control group: 2-hydroxyphytanoyl-CoA lyase conventional liver protecting against hepatic coma therapy, oral or nasal feeding lactulose diabetes 10 ml/, 3 /d. For 1 weeks. Results: Compared with the treatment group and control group, two in treating hepatic encephalopathy has good curative effect. But the two time in awake patients, reduce the blood ammonia level, there was significant difference (P < 0.05). Conclusion: Probiotics to improve the clinical symptoms of the patients with hepatic encephalopathy, lowering blood ammonia, has certain value, conducive to disease in patients with hepatic encephalopathy improvement. Key Word(s): 1. probiotics; Presenting Author: YULI SUN Additional Authors: BAODONG TANG Corresponding Author: BAODONG TANG Affiliations: The first affiliated hospital of Sun Yat-sen University Objective: To assess the efficacy of Bicyclol Tablets in the treatment of nonalcoholic fatty liver disease (NAFLD).

Visual analysis of growth layers in

primary tooth dentin to age marine mammals was first developed on northern fur seals (Scheffer 1950) and has been successfully applied to studies of other marine mammals. Fortunately, primary dentinal growth layers are metabolically inert and are not remodeled, thus collagen or apatite derived from consecutive Decitabine nmr annuli in mammalian teeth can provide annually resolved ontogenetic time series from individual animals. Sophisticated micro-drilling systems are commercially available that can sample growth layers as small as approximately 300-μm thick. Individual growth layers in the teeth of some large odontocetes and pinnipeds can be 1.0–1.2-mm thick, which may allow for subannual resolution. Growth layer thickness does decrease with age such that it may be impossible to sample individual annuli deposited during the adult life stage, and material from several annuli may have to be combined to produce enough material for SIA (Niño-Torres et al. 2006, Knoff et al. 2008). Furthermore, some marine mammal species are sexually dimorphic,

which can result in tooth dentin growth layers in adult male teeth being much thicker than those in a female of comparable age. This technique has been used to assess ontogenetic dietary shifts of Steller sea lions (Hobson and Sease 1998), northern fur seals (Hobson and Sease 1998, Newsome et al. 2006), California sea lions (Newsome et al. 2006), sperm whales (Physeter macrocephalus) (Mendes et al. 2007a,

b), killer whales (Newsome et al. 2009a), longbeaked common dolphin (Delphinus INK 128 molecular weight capensis) (Niño-Torres et al. 2006), and bottlenose dolphins (T. truncatus) (Knoff et al. 2008), as well as dietary shifts associated with weaning that were discussed above. Stable Pb isotopes in walrus (Odobenus rosmarus) dentin have been used to determine stock distinctions and movement patterns in the Canadian Arctic (Outridge et al. 2003, Stewart et al. 2003). Another fruitful future research direction will be to integrate a rapidly growing, high-resolution database on movement and diving derived from satellite telemetry and time-depth recorders with SIA to better understand foraging and to ground truth the use www.selleck.co.jp/products/erastin.html of isotopic data as proxies for habitat use and diet. Satellite tracking offers a rich archive of information at the individual level, but its high cost makes it difficult to deploy to assess behavior at the population level or to examine changes in behavior over multiple years. As described in detail above, SIA is a promising tool for assessing differences in habitat use over relatively large spatial scales (i.e., ocean basin), yet finer scale resolution may be possible by comparing individual isotopic information with high-resolution satellite-derived tracking information. We focus on northern elephant seals to highlight this productive avenue of research.

The prospect of

viral safety associated with FVIII produced from recombinant DNA technology was the main advantage, but additionally, rFVIII could – at least theoretically – become available in unlimited supply. These accomplishments, published in a single issue of ‘Nature’ in 1984 [12–15], were remarkable in view of the size and complexity of the FVIII gene which encompassed 186,000 base pairs and represented 0.1% of the human X chromosome. In a very short time thereafter, in collaboration with scientists at Genentech and the Genetics Institute, two U.S. Pharmaceutical Companies (Miles, Inc./Cutter Biological, Berkeley, CA, and Baxter/Hyland Div., Glendale, CA) accomplished scale-up, purification and standardization of two CP-673451 molecular weight rFVIII products for clinical use. Following preclinical in vitro studies,

and studies in animals, prelicensure clinical trials in patients with haemophilia A began in 1987 [16]. Safety and efficacy in treatment of bleeding episodes and in controlling bleeding in major surgery was documented in adults [17,18]. Recombinate was licensed for use in the U.S. in 1992 and Kogenate was licensed for use in early 1993. In January 1989, a study in previously untreated patients (PUPs) was begun with Kogenate [19], and in July, 1990, the PUP study with Recombinate began [20,21]. Clinicians involved in these early trials with rFVIII products found that it was relatively easy to enrol subjects, all of whom had heard about AIDS and hepatitis with plasma-derived products. In both NVP-BGJ398 concentration of the PUP trials, haemostatic responses were excellent and the products were well tolerated. However, inhibitor antibodies developed early (after a median of 9–11 EDs) in 20–25% of study subjects. Approximately half of the inhibitors in both PUP studies were ‘high responding’ (>5 BU), whereas the remainder were ‘low responding’ and most of these were transient [22–24]. Nevertheless, some clinicians became concerned that recombinant FVIII was causing a higher incidence of inhibitors. ADAMTS5 However, earlier studies in infants and children with severe haemophilia A published in 1992 and 1993 had documented a higher incidence of inhibitor development

with plasma-derived FVIII (25–50%) [25,26] than previously thought. It had become increasingly apparent that, if one looks for inhibitors prospectively, with laboratory monitoring at frequent intervals, 25–35% (or even 50%) of PUPs will develop inhibitors after a median of 9–11 EDs. Roughly one-third of these will disappear despite continued exposure to FVIII given for episodic treatment. In addition, it was becoming increasingly apparent that such findings were not related to a particular type of product, but were seen with plasma-derived as well as rFVIII products [27]. Other analyses were documenting that patient-related factors, such as the severity of haemophilia, FVIII gene mutation causing the person’s haemophilia, race, etc.

8.6.2 Auditable outcome Proportion of patients diagnosed with HCV/HIV receiving a baseline fibrosis stage assessment 8.7 Antiviral treatment:

genotype 1 8.7.1 Recommendations  90. We recommend where there is a current clinical need for treatment (i.e., Metavir F4/cirrhosis), or if the patient wishes to be treated, the standard of care should be with triple therapy consisting of pegylated interferon, ribavirin, and either telaprevir or boceprevir (1C).  91. We recommend 48 weeks of total treatment with a telaprevir- or boceprevir-based regimen for patients who do not have cirrhosis (1C). 8.7.2 Good practice points  92. We recommend all patients should have the option of treatment, and have the pros and cons of opting for initiation of treatment and of deferring treatment discussed with them.  93. We recommend a total of 48 weeks of treatment in patients with cirrhosis this website and for those who do not achieve an RVR.  94. We suggest non-cirrhotic patients who were previously null responders, partial responders or who experienced breakthrough should, wherever possible, wait for the availability of interferon-sparing regimens or interferon-based regimens

Selleckchem MLN0128 including at least two new agents.  95. We recommend that all patients with advanced or decompensated cirrhosis being treated with triple therapy are managed in a tertiary centre.  96. We suggest for patients with genotype 1 infection and non-cirrhotic disease, there is the option to defer treatment until

newer funded therapies or a suitable clinical trial become available. Where deferred, close monitoring should take place with hepatic elastography or alternative non-invasive testing at least annually. Where there is confirmed progression of fibrosis, treatment initiation should be reconsidered. 8.7.3 Auditable outcomes Proportion of patients treated Cell press for genotype 1 outside of clinical trials receiving triple therapy with telaprevir or boceprevir with pegylated interferon and ribavirin Proportion of patients treated for genotype 1 with cirrhosis who are offered treatment with telaprevir or boceprevir with pegylated interferon and ribavirin unless contraindicated Proportion of patients not receiving therapy who undergo repeat non-invasive staging of liver disease within 1 year 8.8 Antiviral treatment: genotypes 2 and 3 8.8.1 Recommendations  97. We recommend where there is a current clinical need for treatment (i.e., Metavir F4/cirrhosis), or if the patient wishes to be treated, the standard of care should be with pegylated interferon and ribavirin (1C).  98. We recommend where patients receive pegylated interferon and ribavirin, the duration of treatment should be 48 weeks unless RVR is achieved, when treatment should be shortened to 24 weeks if the individual is non-cirrhotic (1C). 8.8.2 Good practice points  99.

Results to date in WITS also demonstrate a trend towards decreased arm and thigh muscle masses in infected versus uninfected children, with no evidence that this is changing in the era of HAART [30]. There are several limitations to this study. It is likely that the HIV-infected children in our study differed from the overall US population represented in the NHANES data in ways for which we could not adjust; differences between the WITS uninfected children and the NHANES

population in several anthropometric measures support this speculation. Furthermore, BIA measures were only available in children >8 years of age in NHANES, limiting Barasertib order the utility of BIA in this comparison. NHANES itself consists of cross-sectional data which are not ideal for comparison with data from subjects followed longitudinally. The HIV-exposed, uninfected cohort in WITS is likely to be more similar to our study population than the overall population in NHANES, but the case–control method did not allow generation of z-scores; there were also few matches

selleckchem for the older children. Results of the two comparisons are discrepant in some cases; it is likely that some of these differences are attributable to the different ages represented, as age was significantly associated with multiple measures at both baseline and over the 48 weeks. DNA ligase Other differences may be the result of fewer available matched children in the WITS cohort, resulting in less power to detect changes in case–control differences over time that may be clinically significant. The subjects in our study also began diverse ART regimens, limiting the power to detect changes that may be associated with specific ART class(es). Although

we did not find an association with specific ART classes, all children were on treatment, so it is not possible to sort out the contribution that treatment per se may have to growth and body composition changes. The lack of associations at entry with PI therapy compared with ART or PI naivety suggests that there may not be substantive effects of ART per se on growth or body composition. There were also many comparisons such that some findings of borderline significance may have occurred by chance. Finally, we did not have a comparison group of HIV-infected children who were not beginning or changing therapy, so clearly the associations noted may be different in children on long-term therapy.

“
“Leprosy classically presents with cutaneous and neural involvement. Rheumatological manifestations are frequent, although often under-recognized. At times, selleck compound these may present to a rheumatology clinic prior to the diagnosis of leprosy. Herein, we present our experience with patients referred with various rheumatological disorders who were subsequently diagnosed as having leprosy. This retrospective study (January 2001–September 2010) was carried out at the Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, in northern India. Patients who were confirmed as having leprosy were included. Details regarding demographic and clinical

presentations were collected. Forty-four cases (30 male, mean age 40 ± 13.6 years and mean disease duration 18.7 ± 24.3 months) were identified. Musculoskeletal manifestations included arthritis (n = 22), swollen hands and feet syndrome (SHFS) (n = 11), tenosynovitis (n = 9), painful swollen feet (n = 9), arthralgias (n = 7) and vasculitis (n = 1). Distribution of joints mimicked rheumatoid arthritis

(n = 14) and spondyloarthropathy (n = 7). Arthritis and/or tenosynovitis were part of spontaneous onset lepra reaction in 28 cases. Other clinical manifestations were: paresthesias JQ1 cell line (n = 28), erythematous nodules (n = 25) and anesthetic patches (n = 7). Thirty-one patients had thickened nerves (ulnar n = 28, common peroneal n = 21). Eight patients did not have any cutaneous manifestations and had presented with SHFS and arthritis or tenosynovitis. These were labeled as pure neuritic leprosy. Most

of the patients responded to multidrug anti-leprosy therapy and glucocorticoids. Rheumatological presentations of leprosy may mimic RA, spondyloarthropathy or vasculitis. Pure neuritic variety and spontaneous type 2 lepra reaction pose unique diagnostic challenges. Increased awareness may avoid delay in diagnosis. Protein kinase N1 “
“To assess patient satisfaction with the rheumatology telemedicine service provided to a rural town in northern Australia. A prospective, questionnaire-based exploratory study of patients seen at the Mount Isa (rural town) rheumatology telemedicine clinics during 2012 was undertaken. Control groups included patients travelling over 3 h to be seen face-to-face in Townsville (tertiary referral centre), and patients seen at the infrequent face-to-face clinic in Mount Isa. A 5-point Likert scale was used to explore themes of communication, confidentiality, physical examination, rapport, medication safety and access. This study evaluated 107 rheumatology outpatients (49 telemedicine, 46 face-to-face Townsville, 12 face-to-face Mount Isa). Patients seen in Mount Isa travelled a median of < 10 km for either the telemedicine or local face-to-face appointments. The patients attending the Townsville face-to-face clinic travelled a median of 354 km.

The flow rate was adjusted to 1 mL min−1. The analysis of each sample was performed using the following binary gradient: 100% buffer A for 2 min, followed by sample injection, 100% buffer A for 2.5 min, 0–10% buffer B for 1.5 min, 10% buffer B for 2 min, 10–20% buffer B for 1 min,

20–40% buffer B for 5 min, 40–100% buffer B for 3 min, 100% buffer B for 5 min, 100–0% buffer B for 1 min, and 100% buffer A for 9 min to equilibrate the system for the next analysis. A254 nm was measured for the detection of ATP and ADP using a Waters 996 Photodiode array detector. Xcg cells were grown at 26±2  °C on a rotary shaker (150 r.p.m.) in a culture medium (LB or RSB) for 16 h. A 2-mL aliquot of the culture (108 CFU mL−1) was withdrawn and centrifuged at 12 500 g for 2 min and the pellet was resuspended in 1 mL saline (0.85%). This was CH5424802 mouse then

incubated with 2 μL H2DCFDA (5 mM, prepared in absolute ethyl alcohol) at 37 °C for 30 min. An aliquot was smeared on a glass slide, air dried, and examined under a fluorescent microscope (Carl Zeiss, Germany) using an oil immersion objective (× 100) and filter set 15 (Carl Zeiss; excitation: 546 nm; emission: 590 nm). Hydroxyl radical (OH•) formation inside the cells during the course of PCD was detected using an ESR-based spin trapping system, which contained Selleck Tanespimycin 50 mM POBN and 250 mM DMSO. A 2-mL aliquot of culture grown for 20 h containing around 108 cells mL−1 was mixed with POBN (50 mM) and DMSO (250 mM), and analyzed using an ESR spectrometer (Bruker, Germany). The spin trapping spectra are the result of four signal-averaged scans and were obtained at ambient temperature (26±2 °C). The instrument

settings were as follows: power, 15.94 mW; receiver gain, 7.96 × 104; modulation frequency, 100 kHz; modulation amplitude, 0.920 G; sweep width, 100 G; and sweep time, 83.886 s. The intracellular hydrogen peroxide (H2O2) level was measured using scopoletin assay. An aliquot of Xcg culture was withdrawn and centrifuged at 12 500 g for 5 min. In a fresh tube, 1 mL supernatant was mixed with fluorogenic substrate scopoletin (2.5 μM) and horseradish peroxidase (5 U mL−1), and incubated for 5 min at ambient temperature (26±2 °C). Later, Janus kinase (JAK) the suspension was diluted 1/10 with milliQ water, and the fluorescence intensity was measured (excitation: 360 nm, emission: 465 nm) using a spectrofluorometer (FP-6500; Jasco, Japan). Caspase-3 activity was assayed using the synthetic flurogenic substrate Ac-DEVD-AMC as per the method described earlier (Gautam & Sharma, 2002b). The level of caspase-3 biosynthesis was analyzed using SDS-PAGE and Western hybridization as described earlier (Gautam & Sharma, 2002b) using affinity-purified, biotin-conjugated, polyclonal rabbit anti-active human caspase-3 antibody. The experiments were repeated in three independent sets, each in triplicate, and data were analyzed taking all readings into consideration, and expressed in terms of mean and SD.

CD4 cell count (cells/μL) HBV requiring treatment* HBV not requiring treatment HCV with immediate plan to start HCV treatment* HCV with no immediate plan to start HCV treatment *See BHIVA

guidelines for the management of hepatitis viruses in adults infected with HIV 2013 [31] for indications to treat hepatitis B and C We recommend patients with HIV and hepatitis B virus coinfection who have a CD4 cell count <500 cells/μL are treated with fully suppressive ART inclusive of anti-HBV active antivirals (1B). We recommend patients with HIV and HBV coinfection who have a CD4 cell count ≥500 cells/μL and who have an HBV-DNA ≥2000 IU/mL and/or evidence of more than minimal fibrosis (Metavir ≥F2) are treated with fully suppressive ART inclusive

of anti-HBV active antivirals (1C). Proportion of patients with a CD4 cell count ≥500 cells/μL and an HBV DNA ≥2000 IU/mL learn more and/or evidence of more than minimal Metformin molecular weight fibrosis commencing ART inclusive of anti-HBV antivirals. Rationale. Because of the negative effect of immune depletion on HBV disease progression, the availability of single drugs with high level dual hepatitis B and HIV antiviral activity, and the increased risk of liver-related deaths in patients with CD4 cell counts ≥500 cells/μL, coinfected patients with active HBV disease (HBV viral load ≥2000 IU/mL or Metavir F2 or above) and those with CD4 cell counts below 500 cells/μL should start ART inclusive of anti-HBV active antivirals [2]. Patients Dimethyl sulfoxide with CD4 cell counts ≥500 cells/μL and HBV DNA of <2000 IU/mL, minimal or no evidence of liver inflammation or fibrosis, and a repeatedly normal ALT should be given the option to commence treatment or defer and be monitored not less than 6-monthly with HBV DNA and ALT and at least yearly for evidence of fibrosis.

For more information on the indications to start treatment for hepatitis B infection please refer to the BHIVA guidelines for the management of hepatitis viruses in adults infected with HIV 2013 [31]. We recommend TDF/FTC as part of a fully suppressive ART combination should be given to all patients where HBV treatment is deemed necessary (1C). We recommend neither 3TC nor FTC be used as the sole active drug against HBV in ART due to the rapid emergence of HBV resistant to these agents (1B). We recommend 3TC/FTC may be omitted from the ART regimen and tenofovir be given as the sole anti-HBV active agent if there is clinical or genotypic evidence of 3TC/FTC-resistant HBV or HIV (1D). Proportion of patients with a CD4 cell count <500 cells/μL receiving TDF/FTC or TDF/3TC as part of a fully suppressive combination ART regimen. Proportion of patients receiving 3TC or FTC as the sole active drug against HBV in ART. TDF, FTC and 3TC are agents that have good antiviral activity against both HIV and hepatitis B.