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Pretreatment evaluation of chronic hepatitis B virus infection in the HIV-infected patient

Kenneth E Sherman, MD, PhD
Chloe L Thio, MD
Section Editor
David L Thomas, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The era of potent antiretroviral therapy (ART) has led to declining rates of opportunistic infections and a new focus on other leading causes of morbidity, such as end-stage liver disease secondary to chronic hepatitis B virus (HBV) infection [1].

HIV treatment guidelines generally recommend treatment for HBV among all HIV-infected patients, regardless of the CD4 cell count [2-5]. Among HIV/HBV coinfected patients, ART should include agents with dual activity against HIV and HBV.

The pretreatment evaluation of HBV in the HIV-infected patient will be reviewed here. The epidemiology, clinical manifestations, diagnosis, treatment, and prevention of HBV infection among HIV-infected patients are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV-infected patient" and "Treatment of chronic hepatitis B in the HIV-infected patient" and "Prevention of hepatitis B virus infection in the HIV-infected adult".)


Most HIV-infected patients with chronic HBV will be treated for their HIV and HBV, regardless of the stage of liver disease or their level of immunosuppression (ie, CD4 cell count). (See "Treatment of chronic hepatitis B in the HIV-infected patient", section on 'Deciding whom to treat'.)

The pretreatment evaluation of such patients includes obtaining baseline markers of disease activity (used to monitor the response to therapy), information to determine which antiviral agents to use for HBV treatment, and information to assess for other causes of liver injury and complications of advanced liver disease (eg, varices, hepatocellular carcinoma).

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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