Management of Chronic Hepatitis B in the HIV-Infected Patient

Coinfection with HIV and hepatitis B virus (HBV) is common because of their shared modes of transmission. HIV infection alters the natural history of HBV infection, leading to more severe liver disease, decreased hepatitis B e antigen seroconversion, and higher HBV DNA levels. Furthermore, end-stage liver disease has emerged as a common cause of morbidity and mortality in HIV-infected persons receiving HAART. For these reasons, it is important to vaccinate susceptible persons against HBV infection and to diagnose and treat chronic hepatitis B in HIV-infected persons. The treatment plan for chronic hepatitis B needs to be individualized based on the stage of both viral infections and the available options. It is anticipated that we are entering the period of combination therapy for chronic hepatitis B, but the ideal combination needs to be elucidated.