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Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection occurs commonly. The introduction of antiretroviral therapy can result in immune reconstitution hepatitis. We describe 2 coinfected patients who developed clinical flares of HBV disease, despite the inclusion of lamivudine, a drug with anti-HBV activity, in their HAART regimens. Potential strategies to manage individuals with HBV/HIV coinfection are discussed.