Purpose of Review <p>Liver biopsy and FNA in persons with HIV-HBV coinfection can aid in the assessment of intrahepatic milieu, direct functional cure strategies, and facilitate development of novel therapeutics.</p> Recent Findings <p>Liver tissue sampling provides important insight into the intrahepatic viral reservoir and complex immune microenvironment in HIV-HBV coinfection. Additionally, the development of tissue-based viral markers, specifically cccDNA and integrated HBV DNA, paired with novel, noninvasive biomarkers and advanced techniques for tissue processing and analysis have been instrumental in this process. Hepatic tissue sampling also offers unique insights into treatment responses and understanding deficiencies of existing therapies that cannot be assessed by noninvasive means alone, which informs the development of novel therapeutics.</p> Summary <p>Liver biopsy and liver tissue fine needle aspiration represent important modalities that will continue to drive research and innovation leading to HBV cure strategies.</p>