Managing hepatitis B coinfection in HIV-infected patients

Since viral hepatitis is one of the most common causes of morbidity and mortality in HIV, it is critical to recognize and treat these patients appropriately. Hepatitis B infection is particularly difficult to manage as it changes with shifts in immune status. Inactive infection may flare up with restoration of CD4 cell count. In addition, many drugs used to treat HIV are also active against hepatitis B. Thus, patients may require therapy for both diseases or only for hepatitis B. The practicing physician must be aware of which drug to use with antiretrovirals and which can be used for hepatitis B alone. Current therapies for HIV that have hepatitis B activity include lamivudine, emtricitabine, and tenofovir. Therapies for hepatitis B without HIV activity are adefovir and entecavir. The major advances in the past year include emerging data on epidemiology, occult infection, genotypes, and newer therapies. Long-term management of hepatitis B includes monitoring for hepatocellular carcinoma. Two recent consensus conferences have provided excellent reviews of management of coinfection .