I recently read that they are starting to see hiv patients who have cleared hbv become hbv active again. They believe this to be the result of hiv progression and the immune system weakened.

Is it possible under normal circumstances to control hiv with good adhearance etc. to a level that the immune system can keep already cleared hbv at bay?

Although I have not seen the reports showing reactivation of hepatitis B virus in HIV-infected individuals with weakened immunity I don't doubt this possibility. I think it must be a very unlikely event, especially in people on antiretroviral therapy.

Several of the most commonly used HIV medications have good activity against hepatitis B and we now commonly see co-infected patients going undetectable for hep B as a result of treatment of HIV. In fact, when as we individualize antiretroviral regimens we factor in co-infection with hepatitis B and recommend treating both hepatitis B and HIV with a regimen that contains Viread and either Epivir or Emtriva. With this combination most patients go undetectable for hepatits B as well as HIV. We don't have long-term follow up to see how many of them will keep hepatitis B under control if and when therapy is stopped.

For persons that have already cleared hepatitis B there should almost no risk of reactivation if HIV is well controlled on an antiretroviral regimen.