Hepatitis B virus infection in HIV-infected persons

Coinfection with HIV and hepatitis B virus (HBV) is common due to shared modes of transmission. The extended life expectancy of HIV-infected persons from effective antiretroviral therapy has led to the emergence of chronic hepatitis B (CHB) as an important problem. HIV adversely affects CHB, leading to accelerated progression of liver disease, as evidenced by an increased incidence of cirrhosis and liver-related mortality in coinfected persons. Furthermore, CHB increases the risk of hepatotoxicity from antiretroviral therapy, potentially jeopardizing the efficacy of HIV treatment. For these reasons, HIV-infected persons must be evaluated for coinfection with HBV and, if present, must be considered for CHB treatment. Management of CHB in HIV-infected persons is particularly complex due to lack of controlled trials, inability for current therapeutics to eradicate HBV, overlap in therapeutic agents for both viruses, and potential for development of drug-resistant HBV and HIV. Thus, treatment of HIV-HBV-coinfected patients requires simultaneous consideration of both viral infections. Further research is needed to determine the optimum management of CHB in HIV-infected persons.