Strategies for managing coinfection with hepatitis B virus and HIV

Hepatitis B virus (HBV) infection is more aggressive in individuals coinfected with human immunodeficiency virus (HIV): in the presence of HIV, HBV carrier rates and viremia levels are higher, episodes of activation are more frequent, cirrhosis progresses more quickly, and hepatocellular carcinoma occurs more often than with HBV infection alone. As in HBV monotherapy, the objective of treatment is suppression of viral replication. Standard or pegylated interferon may be appropriate treatment for chronic HBV infection for patients who have not yet started highly active antiretroviral therapy (HAART) for their HIV. When treatment is required for both diseases, the use of a combination of nucleoside and nucleotide analogues is prudent, with careful selection of therapy to reduce the risk of antiviral resistance--a particular concern for patients receiving antiretroviral therapy for both HIV and HBV. HBV DNA levels should be monitored every 3 months; the frequency can be extended to every 6 months once the viral load becomes stable or undetectable.