The prognosis characteristics of HIV/HBV co-infection after antiviral therapy: a comprehensive review

Co-infection of HIV and HBV is still a major global public health concern. Co-infected people have a nearly threefold increased risk of end-stage liver disease, with a noticeably faster development to cirrhosis and hepatocellular carcinoma than those with HIV mono-infection. Based on the information that is now available, antiretroviral regimens that combine lamivudine or emtricitabine with tenofovir (TDF or TAF) can effectively block both viruses, maintain or even partially reverse liver fibrosis, and improve immunological reconstitution. However, HBsAg decrease indicates that a functional cure is still uncommon. In standardized treatment cohorts, long-term HBsAg clearance rates are approximately 15% for African patients and 8%–12% for Asian populations; these discrepancies are likely caused by variations in host immunological profiles and the distribution of HBV genotypes. The severity of baseline liver fibrosis, HBV DNA levels, HBsAg titers, CD4⁺ count, medication adherence, alcohol consumption, and co-infection with HCV or HDV all affect prognosis. There are still significant gaps in our knowledge of the long-term safety of antiviral medications and in the development of cure-oriented approaches. Therefore, to lower liver-related morbidity and increase long-term survival, early diagnosis, timely introduction of ART with HBV-active medicines, and improved adherence support—especially for individuals with severe fibrosis—are crucial.