Abstract： Objective To evaluate the efficacy and safety of de novo combination of tenofovir (TDF) plus lamivudine (LAM) based highly active antiretroviral therapy (HAART) for HBV-HIV coinfected patients.Methods Sixty patients with HBV-HIV co-infections admitted to Wuxi Fifth People's Hospital and Shanghai Public Health Clinical Center during January 2009 and December 2012 were enrolled.The patients were randomly divided into TDF + LAM based HAART group (TDF + LAM group,n =30) and LAM based HAART group (LAM group,n =30).All patients were treated for 72 weeks.SPSS 17.0 was used to compare the ALT normalization rate,HBV DNA negative conversion rate,serological response,HIV RNA negative conversion rate and CD4 + lymphocyte counts elevation rate between two groups at 24-,24-,48-and 72-week.Drug resistance and adverse reaction were observed.Results ALT normalization rates in TDF + LAM group at 24-,48-and 72-week were 83.3％,90.0％ and 93.3％,respectively,which were higher than those in LAM group (x2 =5.079,4.812 and 5.455,P ＜0.05).After 48 weeks of treatment,there were 28 patients (93.3％) in TDF + LAM group with the elevation of CD4 + lymphocyte counts ≥ 150 cells/μL,the rate was higher than that in LAM group (21/30,70.0％) (x2 =5.455,P ＜ 0.05).HBV DNA negative conversion rates in TDF + LAM group at 12-,24-,48-and 72-week were 60.0％,90.0％,93.3％ and 96.7％,respectively,which were higher than those in LAM group (x2 =4.800,5.963,5.455 and 9.017,P ＜0.05).No drug resistance and severe adverse reaction was observed in TDF + LAM group.Conclusion TDF + LAM based HAART is better in HBV viral suppression and liver function normalization,and has lower HBV resistance and higher CD4 + T lymphoeyte counts elevation rate than LAM based HAART for HBV-HIV co-infected patients.