Background:  Approximately 10% of the HIV-infected population has chronic hepatitis B (CH-B), and data demonstrate that these co-infected individuals have accelerated liver disease progression. Thus, effective management of CH-B in the HIV-infected population is important to HIV care. The complexities of treating the HIV/HBV co-infected patient have increased as the therapeutic options for treating CH-B have expanded. Currently, the FDA-approved drugs for the treatment of CH-B include pegylated interferon-alpha-2a, lamivudine, adefovir dipivoxil, entecavir, and telbivudine; the non-FDA-approved drugs include tenofovir disoproxil fumarate and emtricitabine. Of these medications, only telbivudine has no known anti-HIV activity.

Conclusions:  Due to the dual efficacy of many of these agents, the treatment of CH-B in the HIV-infected patient must balance the need for treating each of the 2 viruses, the efficacy of the drugs for both viruses, and the risk of developing resistance. Thus, understanding how the risk for developing HBV resistance varies with each drug, as well as the HBV-resistance patterns is important in the management of the HIV/HBV co-infected patient. In this presentation we will review the indications for treatment of CH-B, the efficacy of these anti-HBV agents, including the resistance data, and we will discuss the optimal use of these agents in the HIV/HBV co-infected individual.