title: Current management and recommendations on hepatitis B therapy in HIV-coinfected patients.
abstract: BACKGROUND
  The match between the real-life therapeutic management of chronic hepatitis B (CHB) in HIV-infected patients and the recommendations that existed at the time has never been assessed on a case-by-case basis.
  
  
  METHODS
  A total of 73 HBV-HIV coinfected patients, 34 of whom were first followed in 2003-2005 and 39 in 2006-2008 (before and after the 2005 European Consensus Conference on the treatment of chronic viral hepatitis in HIV coinfected patients), were included. All the data were retrospectively collected from their first visit to October 2008 through a standardised questionnaire.
  
  
  RESULTS
  Baseline HBV DNA quantification and/or liver histology were missing in 44.1 and 28.2% of cases before and after 2005, respectively (p = 0.16). The observed management significantly differed from the recommendations for the whole population (p = 0.009), for the 2003-2005 group (p = 0.02), and tended to differ for the 2006-2008 group (p = 0.07). Therapeutic management of CHB was in accordance with the recommendations in 27 (57.4%) cases, with a higher rate of untreated patients in the 2003-2005 group, and a high rate of patients on dual therapy in both groups despite the fact that HBV therapy was not recommended.
  
  
  CONCLUSIONS
  Even though global management of HBV-HIV coinfected patients is improving, baseline evaluation of CHB though necessary is still often insufficient. The strong rationale for early dual anti-HIV and anti-HBV therapy, and the reality of everyday clinical practice, bring support to the recent simplification of the recommendations widening the use of tenofovir and emtricitabine in HBV-HIV coinfected patients, irrespective of immunological, virological, or histological considerations.
authors.affiliation: Département d' Infectiologie, CHU Dijon and Université de Bourgogne, 10 boulevard du Maréchal de Lattre de Tassigny, 21079, Dijon Cedex, France. lionel.piroth@chu-dijon.fr.
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.affiliation: Département d' Infectiologie, CHU Dijon and Université de Bourgogne, 10 boulevard du Maréchal de Lattre de Tassigny, 21079, Dijon Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Mahy
authors.affiliation: Service d' Hépatologie, AP-HP, Hôpital Cochin, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Pol
authors.affiliation: Faculté de Médecine Saint Antoine, Inserm U707, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.affiliation: AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.|Université Pierre et Marie Curie, CNRS, UMR 7087, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Sene
authors.affiliation: Service de Maladies Infectieuses, CHU Rouen, Rouen, France.
authors.forename: Manuel
authors.initials: M
authors.lastname: Etienne
authors.affiliation: CHU, Saint Louis, 75013, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lascoux-Combe
authors.affiliation: Service de Médecine Interne, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Simon
authors.affiliation: Service de Maladies Infectieuses, CHU Amiens, Amiens, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Schmit
authors.affiliation: AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.|Université Pierre et Marie Curie, CNRS, UMR 7087, Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub