While vaccination offers hope for a large decrease in hepatitis B (HBV) in the future, many people today are co-infected with HIV and HBV, particularly in regions where both diseases are common.

Gail Matthews from the Kirby Institute in her presentation today described a huge global burden of disease attributed to HIV and HBV and HIV/HBV co-infection. Discussing the management of HIV/HBV co-infection, Gail Matthews noted that HBV co-infection presents unique challenges, especially in resource-limited settings.

Lack of access to routine testing and monitoring is described as one of the major challenges, which include:

• limited access to HBsAg testing, which means many co-infected individuals not identified pre-ART;
• little understanding of natural history of co-infection; liver disease fibrosis assessment not readily available;
• widespread absence of virological monitoring by HBV DNA testing.

Restricted access to Tenofovir in low and middle income countries, lack of routine screening of pregnant women for HBV and low coverage of universal infant vaccination in many countries are also described as the major challenges to the management of HIV/HBV co-infection.

Gail Matthews advocated for the changes at many levels including policy/advocacy, epidemiology, basic science and clinical research in order to overcome those challenges. These include: improved access to drugs; national testing policies; universal and birth dose vaccination; understanding of natural history of co-infection; management and incidence of flare; options for switch of treatment; and cure strategies.