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Highly active antiretroviral therapy (HAART) for the Human Immunodeficiency Virus (HIV) infected patient has ushered in an era of declining opportunistic infections and led to a new focus on other leading causes of morbidity, such as end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HIV co-infected HBV and HCV patients present great challenges in management for the clinician. Knowledge of the complex interactions of these viruses as well as the effect of various treatment modalities on each virus is key to understanding and treating these patients effectively. New laboratory tests and therapeutic options make this an exciting time to care for these patients and offers great hope of a cure.
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