Management of chronic hepatitis B in the HIV-infected patient.

Coinfection with HIV and hepatitis B virus (HBV) is common because of their shared modes of transmission. HIV infection alters the natural history of HBV infection, leading to more severe liver disease, decreased hepatitis B e antigen seroconversion, and higher HBV DNA levels. Furthermore, end-stage liver disease has emerged as a common cause of morbidity and mortality in HIV-infected persons receiving HAART. For these reasons, it is important to vaccinate susceptible persons against HBV infection and to diagnose and treat chronic hepatitis B in HIV-infected persons. The treatment plan for chronic hepatitis B needs to be individualized based on the stage of both viral infections and the available options. It is anticipated that we are entering a period of combination therapy for chronic hepatitis B, but the ideal combination needs to be elucidated.