Management of the Hepatitis B Virus/HIV-Coinfected Patient

All patients with HIV infection should be screened for hepatitis B virus (HBV) infection. Preventive HBV vaccination is less effective in HIV-infected patients than in those without HIV infection. Emtricitabine, lamivudine, and tenofovir disoproxil fumarate (tenofovir) each have activity against HIV and HBV. In HBV/HIV-coinfected patients, if HBV or HIV treatment is needed, it should be initiated with tenofovir and emtricitabine or tenofovir and lamivudine as the nucleoside analogue reverse transcriptase inhibitor backbone of a fully suppressive antiretroviral regimen. If HBV treatment is needed and tenofovir cannot be used safely, entecavir is recommended in addition to a fully suppressive antiretroviral regimen. Initiation of treatment for HBV infection is based on the presence of cirrhosis and on HBV DNA level, alanine aminotransferase level, and biopsy results. Current HBV treatments are associated with low functional cure rates. This article summarizes a presentation by Kenneth E. Sherman, MD, PhD, at the IAS-USA continuing education program held in San Francisco, California, in March 2015.