Antiretroviral therapy and HIV/hepatitis B virus coinfection.

Among human immunodeficiency virus (HIV)-infected individuals, the prevalence of hepatitis B surface antigen (HBsAg) seropositivity is approximately 10-fold higher than in the general population. HIV/hepatitis B virus (HBV)-coinfected patients have an increased risk of cirrhosis and liver-disease-related death. The strategy and management of anti-HBV therapy in HIV-infected persons must take into consideration both viral infections. Among HIV/HBV-coinfected patients, lamivudine promptly inhibits HBV replication. The emergence of resistance to lamivudine has been documented in HBV strains. Adefovir has been shown to be effective in the treatment of lamivudine-resistant HBV in HIV/HBV-coinfected patients. Tenofovir has recently been shown to have significant activity against both HIV and HBV. HBsAg seropositivity has been identified as an independent predictor of highly active antiretroviral therapy-related hepatotoxicity. However, further research is needed to determine the exact role of HBV and the mechanisms involved in antiretroviral-associated hepatotoxicity in HBV/HIV-coinfected patients.