Treatment of hepatitis B virus (HBV) in the setting of HIV-HBV co-infection

Liver disease in individuals with HIV-HBV co-infection is now a major cause of mortality worldwide, including Asia. The pathogenesis of liver disease in this setting is multifactorial, but includes drug toxicity and immunological factors, such as immune restoration disease. Staging of chronic hepatitis B is important prior to commencement of anti-retroviral therapy and should include quantification of HBV DNA, and, where possible, an assessment of liver fibrosis, either by liver biopsy or non-invasive measurement. Earlier treatment of both HIV and HBV is now generally advocated, and treatment is usually life-long.