Management of patients co-infected with hepatitis B virus and HIV

The management of chronic hepatitis B virus (HBV) infection poses specific problems in the presence of HIV coinfection, since therapeutic approaches have to consider both HBV and HIV infections. There are currently four drugs approved for the treatment of chronic HBV infection (interferon alpha, lamivudine, adefovir, and entecavir); the dual antiviral activity of tenofovir and emtricitabine broadens the armamentarium against HBV in HBV/HIV co-infected patients. Nucleotide analogues-eg, adefovir and tenofovir-have the advantage of a higher genetic barrier to the development of resistance compared with nucleoside analogues-eg, lamivudine and emtricitabine. Fortunately, the two families do not share resistance mutations, allowing salvage therapy and the possibility of combination therapy for drug-naive individuals. Although response to interferon a is poorer in HBV/HIV co-infected patients compared with HIV-negative individuals, especially in hepatitis B e antigen-negative HBV infection, the more potent pegylated forms of interferon alpha have brought new hope.