Current treatment of HIV/hepatitis B virus coinfection
Article first published online: 8 APR 2008
© 2008 The Authors
Journal of Gastroenterology and Hepatology
Volume 23, Issue 5, pages 699–706, May 2008
How to Cite
Iser, D. M. and Sasadeusz, J. J. (2008), Current treatment of HIV/hepatitis B virus coinfection. Journal of Gastroenterology and Hepatology, 23: 699–706. doi: 10.1111/j.1440-1746.2008.05382.x
- Issue published online: 8 APR 2008
- Article first published online: 8 APR 2008
- Accepted for publication 18 January 2008.
- hepatitis B;
- HIV/hepatitis B coinfection;
Coinfection with HIV and hepatitis B virus (HBV) has become a significant global health problem. Liver disease is now one of the leading causes of morbidity and mortality in individuals with HIV, particularly those with viral hepatitis. There are a number of agents available with dual activity against HIV and HBV, and effective treatment depends on understanding the potential advantages and pitfalls in using these agents. There are a number of unresolved issues in the management of HIV/HBV coinfection. These include the role of liver biopsy, the significance of normal aminotransferase levels, serum HBV DNA threshold for treatment, treatment end-points, and the treatment of HBV when HIV does not yet require treatment. Treatment of HBV should be considered in individuals with HIV/HBV coinfection with evidence of significant fibrosis (≥F2), or with elevated serum HBV DNA levels (>2000 IU/mL). Sustained suppression of serum HBV DNA to below the level of detection by the most sensitive available assay should be the goal of therapy, and, at present, treatment of HBV in HIV/HBV coinfection is lifelong. If antiretroviral therapy is required, then two agents with anti-HBV activity should be incorporated into the regimen. If antiretroviral therapy is not required, then the options are pegylated interferon, adefovir or the early introduction of antiretroviral therapy. Close monitoring is necessary to detect treatment failure or hepatic flares, such as immune reconstitution disease. Further studies of newer anti-HBV agents in individuals HIV/HBV coinfection may advance treatment of this important condition.