“My doctor changed my HIV medications, and now my hepatitis B is back”

This chapter reviews the evaluation and management of a patient with HIV and hepatitis B virus (HBV) co-infection who has an acute rise in liver function tests (LFTs) after a change in his HIV regimen. Abnormal LFTs in a patient with HIV require a thorough workup, including review of medications, history, laboratory evaluation, and often an ultrasound. It describes the reasoning for being placed on active agents for both HIV and HBV. It recommends the use of a tenofovir-containing backbone in antiretroviral therapy (ART) and avoidance of lamivudine monotherapy. A change in ART that does not cover HBV could precipitate HBV rebound and a rise in LFTs.