Hepatitis B in Patients Coinfected with HIV

Hospital Physician October 2008 17 H epatitis B virus (HBV) and HIV are often found coinfecting a single patient because the pathogens share transmission routes. The prevalence of HBV/HIV coinfection varies by geographic region and risk factor exposure, but studies suggest that up to 10% of patients with HIV have chronic HBV coinfection.1,2 The impact of HIV infection on the course and outcome of HBV infection is considerable. Infection with HIV not only increases the risk that a person will progress from acute infection to chronic HBV infection, but can also accelerate the progression of liver disease, resulting in increased morbidity and mortality. Furthermore, the management of the coinfected patient is complex as the presence of one infection can affect the management of the other in a number of ways. HBV infection increases the risk for hepatic toxicity associated with HIV antiretroviral therapy (ART). Because several antiviral agents have activity against one or both viruses, the issues of HIV and HBV drug resistance must be considered when selecting therapeutic regimens. In addition, patients are at risk for hepatic flares and decompensation throughout the disease course, particularly with immune reconstitution during ART. Unfortunately, there is a paucity of studies evaluating treatment of coinfected patients, and evidence to guide therapeutic decision making is often lacking. This article reviews the epidemiology and natural course of HIV/HBV coinfection and discusses the current state of therapy for HBV disease in the HIV-coinfected population. Detailed discussion of HIV ART is beyond the scope of this article.