Although healthy adults who are infected with HBV have a less than 10% chance of seeing the infection develop into chronic hepatitis B, when an HIV-positive adult is infected, this risk jumps to almost 25%. In other words, people with HIV are more likely to develop chronic hepatitis B as a result of HBV infection than HIV-negative people with strong immune systems.
A number of reports have also suggested that, as HIV disease progresses, the body's immune response to HBV gradually decreases or is sometimes lost. This can cause the virus to become active again after being inactive, which can once again increase the risk of liver damage.
It is not entirely understood what impact HIV has on the severity of chronic HBV infection. There have been a number of reports showing that people infected with both viruses have higher HBV viral loads and more cirrhosis, regardless of immune system status. There are also data from studies suggesting that people with HIV with chronic hepatitis B are more than twice as likely as their HIV-negative counterparts to experience liver failure, thus requiring consideration of a liver transplant. It is not yet known if people with HIV with chronic hepatitis B are at a higher risk of liver cancer than their HIV-negative peers, but given the strong link between HBV and liver cancer, this would seem to be likely.
As discussed in the next section, people co-infected with HIV and chronic hepatitis B need to be careful when choosing treatments for both infections.
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