Complications in treating chronic hepatitis B in patients with HIV

The management of chronic hepatitis B virus (HBV) poses specific problems in the presence of HIV infection, as therapeutic approaches have to consider both HBV and HIV. There are currently four drugs approved for the treatment of chronic HBV. IFN-α, lamivudine, adefovir and entecavir. Furthermore, the dual antiviral activity against HIV and HBV of antiretrovirals such as tenofovir and emtricitabine broadens the armamentarium against HBV in the HIV-coinfected population. Nucleotide analogues adefovir and tenofovir have the advantage of a higher genetic barrier for resistance when compared with the nucleoside analogues lamivudine and emtricitabine. Fortunately, the two families do not share resistance mutations, allowing salvage therapy and the consideration of combination therapy for drug-naive individuals. Although response to IFN-α is poorer in HBV/HIV-coinfected patients compared with HBV-monoinfected individuals, the more potent pegylated forms of IFN-α have brought new hopes.