HIV with Hepatitis B Co-Infection: Optimizing Treatment in Resource-Limited Settings

Abstract

Hepatitis B infection is a major cause of morbidity and mortality in HIV-infected patients. While the majority of persons infected with hepatitis B are found in the developing world and were infected at birth or in early childhood, most studies in HIV and HBV co-infection have been conducted in developed countries, where the main modes of transmission are either intravenous drug use or sexual transmission. The few studies that have been conducted in resource-limited settings have very few patients, and the laboratory parameters for proper evaluation of these studies are frequently incomplete. The applicability of United States and European guidelines for HBV-co-infected HIV patients in resource-limited settings (RLS) is therefore uncertain, and may be constrained by financial issues especially with regard to appropriate initiation of antiretroviral treatment. This review discusses the few studies conducted in RLS, and proposes guidelines for treatment based on the best available evidence from these studies. In addition, the effect of co-infection on disease progression, including the role of HBV genotypes and HIV subtypes and the use of hepatitis B vaccination in HIV infection is reviewed.