HIV and hepatitis B coinfection in Southern Africa: A review for general practitioners

Sub-Saharan Africa is facing serious HIV and hepatitis B epidemics, with coinfection becoming a major public health problem. In addition, the prevention and treatment of concurrent illnesses such as hepatitis B in HIV-infected people is becoming increasingly important as their life expectancy lengthens due to treatment with highly active antiretroviral therapy (HAART). Despite the important epidemiological burden and clinical consequences of coinfection, there is a paucity of research to inform practice that derives from studies conducted in highly endemic regions. This article reviews the current status and limitations of knowledge on coinfection with the hepatitis B virus (HBV) and HIV. It will examine the basic epidemiology of coinfection; the implications for disease progression of each condition; the therapeutic implications including drug toxicities; and current evidence and guidelines for the use of vaccine-based prevention strategies. In addition the article highlights critical areas for future research on coinfection in sub-Saharan Africa.