The HIV/HBV co-infected patient: Time for proactive management

Abstract

Hepatitis B virus (HBV) infection affects around 240 million people worldwide, with the highest prevalence of disease in Africa and Asia. Hepatocellular carcinoma (HCC) is the second most common cancer in men in Africa, and in around 75% of cases is associated with chronic HBV infection. HIV disproportionately affects sub-Saharan Africa. HIV/HBV co-infection is associated with worse outcomes than HBV monoinfection. Identifying patients who are co-infected enables assessment of liver health and the institution of HCC surveillance. HBV rapid tests are available and could be performed alongside HIV screening. Suppression of HBV viral load reduces complications and improves outcomes. Tenofovir has potent activity against HBV and is becoming increasingly available across sub-Saharan Africa as first-line therapy for HIV. HIV/HBV co-infected patients should be started on HBV active therapy, irrespective of CD4 count. Lifestyle modification, including weight management, avoidance of traditional herbal medication and alcohol restriction, improves liver health and should be encouraged. Confirmation of hepatitis A immunity is prudent. While access to more sensitive tests is limited in sub-Saharan Africa, alpha-fetoprotein and ultrasound scanning is advised for HCC surveillance. Screening and if necessary HBV vaccination of susceptible household and sexual contacts is indicated.